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Full text of "An epitome of the reports of the medical officers to the Chinese Imperial Maritime Customs Service, from 1871 to 1882 : with chapters on the history of medicine in China, materia medica, epidemics, famine, ethnology, and chronology in relation to medicine and public health"



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CHARLES WILLIAM WASON 
COLLECTION 

CHINA AND THE CHINESE 



THE GIFT OF 

CHARLES WILLIAM WASON 

CLASS OF 1876 

1918 



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AN EPITOME OF THE 

REPORTS OF THE MEDICAL OFFICERS 



TO THE 



CHINESE IMPERIAL MARITIME CUSTOMS SERVICE, 



FEOM 1871 TO 1882. D/ 



7/3 



WITH CHAPTERS ON THE HISTORY OF MEDICINE IN CHINA ; 

MATERIA MEDIGA; EPIDEMICS; FAMINE; ETHNOLOGY; AND CHRONOLOGY 

IN RELATION TO MEDICINE AND PUBLIC HEALTH. 



SUEGEON-GENEEAL C. A. GOEDON, M.D., C.B., 

Honorary Physician to Her Majesty tlie Queen, 

AUTHOB OF ' CHINA FEOM A MEDICAL POINT OF VIEW,' ' DUB TKIP TO BUEMAH,' ' ESPEEIENCES OF A BEGIMBNTAL SUBGiKON IN INDIA,' 

'LIFE ON THE GOLD COAST,' 'LESSONS IN HYGIENE AND SUEGEET FEOM THE FEANCO-PEUSSIAN WAE,' 'AKMT HTSIENE,' 

' AKMT SUESEONS AND THEIE WOKKS,' ' HYGIENE OF CHOLEKA,' ' THE SOLDIEE's HANDBOOK OF SANITATION ' 

'THE PEENCH AND BEITISH SOLDIEE,' ETC., ETC. 




LONDON : 
BAILLII^RE, TINDALL, AND COX, 20, KING WILLIAM STREET, STRAND. 



1884. 



'Shi© '?3fll«int ie 3ingmbelti 

TO 

SIR EOBEET HAET, K.O.M.G., 

INSPECTOR-GENERAL OP CHINESE IMPERIAL MARITIME CUSTOMS, 

IN APPRECIATION OP 

THE ENLIGHTENED MEASURES INITIATED BY HIM IN DIRECTING THE 

PREPARATION OF REPORTS BY MEDICAL OFFICERS 

OP THE 

CHINESE CUSTOMS SEEVICE. 



The following is a list of gentlemen whose able contributions to the Eeports of the Customs 
Service have furnished materials for the present volume, namely : — 

Aldeidge, E. a., L.K. and Q.C.P., Hoihow. 

Begg, a, M.B., C.H.M., Hankow. 

Blaik, Gr. H., Esq., Shanghai. 

Brereton, J. a, L.K. and Q.C.P., L.E.C.S.I., Chefoo. 

Carmichael, J. E., M.D., F.E.C.S., Chefoo. 

Carrow, F., M.D., Canton. 

Deane, a. S., L.K. and Q.C.P., Wuhu. 

Dudgeon, J., M.D., C.H.M., Peking. 

DuGAT, Mons. E., Peking. 

Eldeidge, S., M.D., Yokohama. 

Eraser, J., L.E.C.S.I., L.E.C.P.E., Tientsin. 

Henderson, W., A.L.F.P. and S.G-., Shanghai, Ningpo. 

Henry, A., M.A., L.E.C.P.E., L.E.C.S.E., Ichang. 

Irwin, A., L.K. and Q.C.P., L.E.C.S.I, Tientsin. 

Jamieson, E. a., M.A., M.D., M.E.C.S., F.E.G.S., Shanghai. 

Jaedine, J., M.D., C.H.M., Kiukiang. 

Jones, 0. M., F.E.C.S., Amoy. 

LowRY, J. H., L.E.C.P.E., LE.C.S.E., Pakhoi. 

Macgowan, D. J., M.D., W^nchow. 

Mackenzie, J. H., M.D., L.E.C.S.E. 

Manson, p., M.D., M.C,H., Amoy. 

Manson, D., M.D., C.H., Takow, Tawanfoo. 

McEarlane, E. p., L.E.P. and S.G., Ichang. 

Meadows, Dr. E., Ningpo. 

Muller, Aug., M.D., Amoy. 

Myers, W. W., M.D., M.C.H., Chefoo. 

Platt, a. E., M.D., Chiukiang. 

Pollock, J., L.K, and Q.C.P., L.E.C.S.I., Swatow. 



Vlll 

Eeid, a. G., M.D., F.R.C.S.I., Hankow. 

Eennie, T., M.B., M.C.H., Takow, Tawanfoo. 

EiNGEE, B. S., M.E.C.S., L.S.A., Ningpo. 

Scott, H. M., L.E.C.S.I., Swatow. 

Sheaeer, Dr. George, Hankow, Kiukiang. 

Simmons, D. B., M.D., Yokohama. 

SoMEEViLLE, J. E., M.D., F.E.C.S.E., Pagoda Anchorage, Foochow. 

Stewart, J. H., M.D., Foochow. 

Underwood, G. E., M.B., C.H.M., Kiukiang. 

Wales, J. F., M.D., C.H.M, Canton. 

Watson, J., M.D., L.E.C.S.E., Newchwang. 

White, E. G., L.S.A., M.R.C.S., Chiukiang. 

Wong, Dr. F., Canton. 

If in the above list any name.g have by mistake been omitted, I shall be very sorry. My desire 
is to give full credit to each and all the medical gentlemen whose reports I have endeavoured to 
give abstracts of; and with this view I have endeavoured also to give their several names in con- 
nection with individual extracts from those documents. 



CONTENTS. 



PART I. 

LOCAL CONDITIONS IN RELATION TO PTJBLIG HEALTH. 



I. 


PEKING - 


- 


II. 


TIENTSIN - 




III. 


NEWCHWANG 




IV. 


CHEFOO - 




V. 


CHINKIANG 


. 


VI. 


WUHU 




VII. 


KIUKIANG 


- 


VIII. 


HANKOW - 




IX. 


ICHANG - 


- 


X. 


SHANGHAI 


- 


XI. 


NINGPO - 


- 


XII. 


WENCHOW 


- 


XIII. 


FOOCHOW - 


- 


XIV. 


AMOY 


- 


XV. 


TAMSUI AND 


KELUNG - 


XVI. 


TAKOW AND 


TAIWAN-FOO 


XVII. 


SWATOW - 


- 


XVIII. 


CANTON - 


- 


XIX. 


HOIHOW - 


- 



PART II. 

MEDIC AL. 
HISTORICAL NOTICES OP MEDICINE IN CHINA, AND OF CERTAIN EPIDEMICS, ETC. 

DISEASES. 
I. SMALL-POX, VACCINATION, INOCULATION 
II. MEASLES - - - 

(a) PUNG-SIIA, OR 'WIND MEASLES' 

III. SCARLET FEVER 

IV. DENGUE ... 

V. CONTINUED FEVERS, ETC. ..... 

VI. PERIODIC, AND ' MIXED ' FEVERS, AND ' MALARIAL DISEASES ' 
VII. SOME CHINESE VIEWS REGARDING FEVERS 
VIII. HEAT MALAISE AND HEAT APOPLEXY 

IX. PLAGUE - - ... 

X. CHOLERA ...... 

(a) QUARANTINE 
XI. DIPHTHERIA - ... 

XII. WHOOPING-COUGH . . - - 

XIII. MUMPS .... 

XIV. INFLUENZA - - - - 

XV. SEPTICEMIA AND PYEMIA ...... 

XVI. ERYSIPELAS ... 

XVII. RHEUMATISM - ... 



1 

9 

10 
15 
19 
21 
22 
25 
28 
29 
39 
41 
43 
49 
54 
55 
60 
62 
67 



69 



74 

82 

84 

85 

86 

87 

102 

117 

121 

123 

124 

138 

139 

140 

141 

142 

142 

143 

143 



'^ CONTENTS. 

PAGE 

XVIII. VENEREAL DISEASES - - - . . . 144 

XIX. CANCER - .... 149 

XX. LEPROSY - . . . - 150 

XXI. ELEPHANTIASIS - - . . -154 

XXII. LYMPH SCROTUM - . . . 15G 

XXIII. PHTHISIS. HAEMOPTYSIS - - . ... 158 

XXIV. PURPURA AND H^MOPHILA , . ICO 

XXT. SCURVY, ship's HYGIENE - . 101 

XXVI. ANjEMIA - . ICl 

XXVII. BERI BERI - 102 

XXVIII. DISEASE OP THE BRAIN AND NERVOUS SYSTEM - - 104 

XXIX. 'the PRESSURE' - - . . 164 

XXX. 'FOX DISEASE'- . . . - 165 

XXXI. TETANUS - . . . . 105 

XXXII. RABIES ... . . . - 166 

XXXIII. DELIRIUM TREMENS - . . . . 172 

XXXIV. EAR-ACHE - - . . . . - 172 

XXXV. DISEASES OF THE EYES - . 172 

XXXVL DISEASE OF THE HEART AND ANEURISM .... . " - 173 

XXXVIL PULMONIC DISEASES - . . . 176 

XXXVIII. LARYNGEAL CATARRH - . . . - 177 

XXXIX. ASTHMA - . ...... 177 

XL. A LEECH IN THE NOSTRIL - . . . . . 178 

XLL CANCRUM ORIS .... . . 178 

XLIL DISEASE OF THE TEETH - . . . 179 

XLIII. QUINSY ---... . 179 

XLIV. PECULIAR AFFECTION OP THE THROAT - - - 179 

XLV. DYSPEPSIA - - . . . 180 

XLVI. DYSENTERY AND DIAREHCEA . ... 180 

XL VII. SPRUE .... . 187 

XLVIII. PROCTITIS - . . . . . 187 

XLIX. HERNIA - - 188 

L. AFFECTIONS OF THE LIVER . - 188 

LI. VESICAL CALCULUS AND KIDNEY DISEASE 190 

LIL SKIN DISEASES GENERALLY - . ... 192 

LIII. URTICARIA - ... . lg3 

LIV. PRICKLY HEAT - .... . . 193 

LV. ECTHYMA IN WORKERS AMONG SALT, ALSO LACQUER ECZEMA - - 193 

LVI. DISCOLORATIONS . . . . . 194 

LVII. ULCERS - . . 194 

LVIII. BOILS - - . . . - 195 

LIX. CARBUNCLE . - . . . . - 197 

LX. GANGRENE FROM COLD . - - 197 

LXr. 'SYMMETRICAL' TUMOURS . . . . 199 

LXII. DERMATOLYSIS . - . ... - 199 

LXIII. FORMICATION . . . . - - 199 

LXIV. TINEA IMBRICATA - ..... 200 

LXV. washerman's ITCH .... 200 

LXVI. ITCH ... ... - 201 

LXVII. INTESTINAL WORMS . - .... . - 201 

LXVIII. FILARIA SANGUINIS HOMINIS ... - - 203 

LXIX. DISTOMA RINGERI . . . . 206 

LXX. TRICHINA ... . . . 207 

LXXI. POISONIXC! BY GOLD .... - - 207 



CONTENTS. XI 

PACE 

LXXII. SNAKE-BITE - - - - .... 208 

LXXIII. THE FLESH OP DISEASED ANIMALS AS FOOD - - - - 208 

LXXIV. THE MILK OP DISEASED COWS ... . . 209 

LXXV. ALCOHOLISM, AND POISONING BY FISH AND SHELL-FISH - - 210 

LXXVI. POISONING BY CASTOE-OIL SEEDS .... 211 

LXXVII. POISONING BY OPIUM - - .... 212 

LXXVm. OPIUM-SMOKING ... - 214 

LXXIX. ALCOHOLISM AND DELIRIUM TREMENS - 217 

LXXX. CHILDBIRTH, AND DISEASES CONNECTED THEREWITH - - 217 

LXXXI. CAPACITY OP EUROPEAN WOMEN TO NURSE THEIR INFANTS - - 220 

LXXXII. ARTIFICIAL SECRETION OP MILK .... - - 221 

LXXXIII, SICKNESS AND HEALTH OP EUROPEAN CHILDREN - - - 222 



VAEIOUS. 

LXXXIV. LESIONS FROM PUNISHMENT 

LXXXV. REQUEST FOR MUTILATION 

LXXXVL BANDAGING THE FEET OF CHINESE GIRLS 

LXXXVII. CHINESE NOMENCLATURE OF THE RING FINGER - 224 

LXXXVIII. DIGITAL SIGNATURES - - - 224 

LXXXIX. CHINESE EUNUCHS - - ... 225 



223 

224 
224 



PART III. 

THERAPEUTICS AND DRUGS. 

I. HISTORICAL NOTICES - - - .... 226 

II. AILANTHUS GLANDULOSA - - 227 

III. ARSENIC . - . - 229 

IV. CITRATE OF CAFFEINE 22'J 
V. CANNABIS INDICA - - 229 

VI. CARBOLIC ACID - - 230 

VII. CHRYSOPHANIC ACID - 230 

VIII. COD LIVER-OIL - ...... - 231 

IX. DATURA - • 231 

X. EUCALYPTUS ... 231 

XI. IODINE - - - 232 

XII. IODOFORM - - - 232 

XIII. IPECACUANHA • - - 232 

XIV. LU-SHUI - - • 233 

XV. PARTURIFACIENTS - - 233 

XVI. QUININE - . . - . - . 234 

XVII. SALYCILIC ACID - - - - 235 

XVIII. TONGA - - - - " 236 

XIX. MEMORANDUM ON TREAK FAROOK, OR THERIACA ANDEOMACHI - - 236 

XX, MEMORANDUM ON MITHRIDATE - 239 

XXI. MEMORANDUM ON OLEUM NIGRUM 239 

XXII. MINERAL WATERS - - - 240 

XXIII. THE NATURAL SCIENCES IN RELATION TO MEDICINE - 241 

XXIV. MAJEEIA MEDICA - - - " 247 

(a) FROM THE VEGETABLE KINGDOM - - - 248 

(6) FROM THE ANIMAL KINGDOM 203 

(c) FROM THE MINERAL KINGDOM - - i!<J6 

XXV. MEMORANDUM ON CERTAIN DRUGS FORMERLY USED IN EUROPE 2G8 

XXVI. FURTHER REMARKS ON MEDICINE IN CHINA - - - 270 



Xll CONTENTS. 

PART IV. 

SOME DISEASES OF ANIMALS. 

I. EPIZOOTICS AFFECTING DOMESTIC ANIMALS GENERALLY 
II. DISEASES AFFECTING CATTLE - 

III. DISEASES AFFECTING HORSES AND MULES 

IV. FILARIA IN DOGS 

V. DISEASE AFFECTING POULTRY 
VI. PLAGUES OF LOCUSTS AND CATERPILLARS 



PAGE 

275 
275 
277 
278 
280 
280 



281 
281 
285 
286 
287 
287 
288 
288 
288 
290 
290 
292 
292 
295 
295 



APPENDIX, 

I. TIENTSIN 

II. NKWCHWANG 

III. CHEFOO 

IV. KIUKIANG 
V. YAXGCHOAV 

VI. NANKING 
VII. NANG-CHANG 
VIII. HANKOW 
IX. ICHANG - ..... 

X. SOOCHOW 

XI. SHANGHAI - ... 

XII. IIANGCHOW 
XIIL NINGFO 
XIV. WENCHOW 
XV. A5I0Y 

XVI. CANTON - - - 295 

XVII. PAKHOI - 296 

XVIII. SMALL-rOX, INOCULATION, VACCINATION 297 

XIX. MEASLES - 301 

XX. SCARLATINA - 301 

XXI. CONTINUED FEVERS 301 

XXII. HEAT MALAISE, AND HEAT APOPLEXY 301 

XXIII. PERIODIC FEVERS 302 

XXIV. PLAGUE (?) AT PAKHOI - - - 302 
XXV. DIPHTHERIA - - - 304 

XXVI. MUMPS - 307 

XXVII. ERYSIPELAS - 307 

XXVIII. LEPROSY 307 

XXIX. BERI BERI - - - - 313 

XXX. RABIES - 313 

XXXI. DYSENTERY - 314 

XXXII. CALCULUS - - - 314 

XXXIII. REGARDING OBSTETRICS AND INFANTILE DISEASES 315 

XXXIV. EPIDEMICS - - - 325 

XXXV. NOTES ON THE GREAT FAMINE OF 1877-8 384 

XXXVI. NOTE ON THE ETHNOLOGY OF CHINA - - - 391 

XXXVII. NOTE ON CHINESE CHRONOLOGY IN RELATION TO MEDICINE AND PUBLIC HEALTH - 398 

XXXVIII. TABLE OP CHINESE WEIGHTS - . - 426 

XXXIX. TABLE OP CHINESE MEASURES 426 

XL. TABLE OF CHINESE MONEY 426 

XLI. TABLE OP HONG KONG MONEY - 427 

XLII. TABLE OP SIAMESE MONEY 427 

XLIII. NOTE ON SIAMESE WEIGHTS 427 

XLIV. TABLE OF SIAMESE MEASURES - - 427 

XLV. TABLE OP EXCHANGE .... ... . . 428 



INTRODUCTORY REMARKS. 



The publication of the Medical Reports, an epitome of which is given in the following pages, 
was, in the iirst instance, suggested by Dr. Jamieson, of Shanghai, to Sir Robert Hart, the 
Tnspector-Oeneral of Chinese Imperial Maritime Customs ; and the instructions, formulated by Dr. 
Jamieson, relative to the arrangement to be followed in the preparation of those reports, and also 
for their periodical publication, were embodied by Sir Robert Hart in a circular addressed by him 
to the Commissioners of Customs at the Treaty Ports, dated Peking, 31st December, 1870, of which 
the following is a copy, namely : — 

' 1. — It has been suggested to me that it would be well to take advantage of the 
circumstances in which the Customs Establishment is placed, to procure information 
with regard to disease amongst foreigners and natives in China; and I have, in con- 
sequence, come to the resolution of publishing half-yearly, in collected form, all that may 
be obtainable. If carried out to the extent hoped for, the scheme may prove highly useful 
to the Medical Profession both in China and at home, and to the public generally. I there- 
fore look with confidence to the co-operation of the Customs Medical Officer at your port, 
and rely on his assisting me in this matter by framing a half-yearly report containing the 

result of his observations at upon the local peculiarities of disease, and upon diseases 

rarely or never encountered out of China. The facts brought forward and the opinions 
expressed will be arranged and published, either with or without the name of the physician 
responsible for them, just as he may desire. 

' 2. — The suggestions of the Customs Medical Officers of the various ports as to the 
points which it would be well to have especially elucidated, will be of great value in the 
framing of a form which will save trouble to those members of the Medical Profession, 
whether connected with the Customs or not, who will join in carrying out the plan proposed. 
Meanwhile I would particularly invite attention to — 



^1^ INTRODUCTORY REMARKS. 

'a.— The general health of during the period reported on; the death-rate 

amongst foreigners ; and, as far as possible, a classification of the causes of death. 

' h. — Diseases prevalent at 

' c. — General type of disease ; peculiarities and complications encountered ; special treat - 
ment demanded. 

1 Season. 
Alteration in local condition — such as drainage, etc. 
Alteration in climatic conditions. 
' e. — Peculiar diseases ; especially leprosy. 
r Absence or presence. 

, . „ . , . ) Causes. 
•/. — Epidemics (^ 

] Course and treatment. 

l^ Fatality. 
Other points, of a general or special kind, will naturally suggest themselves to medical 
men; what I have above called attention to, will serve to fix the general scope of the 
undertaking. I have committed to Dr. Alex. Jamieson, of Shanghai, the charge of 
arranging the reports for publication, so that they may be made available in a convenient 
form. 

' 3. — Considering the number of places at which the Customs Inspectorate has established 
ofices, the thousands of miles north and south and east and west over which these offices 
are scattered, the varieties of climate, and the peculiar conditions to which, under such 
different circumstances, life and health are subjected, I believe the Inspectorate, aided 
[by its Medical Officers, can do good service in the general interest in the direction indi- 
cated ; and, as already stated, I rely with confidence on the support and assistance of 
the Medical Officer at each port in the furtherance and perfecting of this scheme. You 

will hand a copy of this Circular to Dr , and request him, in my name, 

to hand to you in future, for transmission to myself, half-yearly reports of the kind 
required, for the half-years ending 31st March and 30th September — that is, for the Winter 
and Summer seasons.' 

The enumeration of the subjects to be noticed is sufficient to indicate the extent of ground to be 
thus included, and also the importance attached to the several points by the Inspector-General. 

The manner in which the instructions have been carried out reflects the highest credit on the 
Medical Officers and on the Service to which they are attached, whilst to themselves as members of 
the Medical Profession, the Profession must remain indebted for much, not only of interest, but of 
real importance, in relation to many scientific questions yet unsettled. To Dr. Jamieson, the able 



INTRODUCTORY REMARKS. XV 

and talented Editor of the Eeports, especial acknowledgment is due, not only for the manner in which 
he has exercised the office, but also for the many valuable papers he has contributed to the series 
of Reports. 

In compiling the following summary of Eeports, in themselves of great value, I have adhered as 
closely as possible to the language of those documents. With a view also to facilitate reference, I 
have noted in connection with each paragraph of the Epitome the number and page of the original 
Eeport from which it is quoted. 

The extent and variety of subjects discussed by the Medical Officers connected with the Imperial 
Maritime Service of China may be readily estimated by reference to the enumeration contained in 
the list of Contents of the present volume. It will thus be seen that the Eeports submitted by those 
officers contain not only a survey of matters more purely medical in their nature, but also many 
which bear upon physical geography, climate, agriculture, commerce, natural history, etc. 

It is impossible to go minutely through the Eeports in question without arriving at the conclusion 
that in many respects details contained in them do not support theories which for the time being 
occupy a good deal of professional attention in England in regard to the etiology of what are called 
• zymotic diseases,' — on the contrary, they are in direct opposition to some at least of those theories. 
This is a point of view the importance of which is manifest alike in its bearings on the causation of 
the very large class of diseases so designated, and, most important of all, in the treatment of persons 
suffering from those diseases. In this connection the original observations of Dr. Manson on the 
apparent connection between the occurrence of intermittent fever and the presence in the blood of 
the Filaria sanguinis hominis, are specially worthy of note. His studies of the life-history of this 
malaria present some very remarkable features and are of the highest interest. 

The remarks quoted in reference to the health-state of foreign residents at the several Treaty 
Ports are valuable. They are also encouraging to those who are in China, or who contemplate pro- 
ceeding to that vast country. 

The observations by resident Medical Officers in reference to habits of life, exercise, gymnastics, 
etc., deserve particular attention. 

Many of the remarks quoted having reference to the management and treatment of foreign 
children in China are of much value. 

Some items of information given by Medical Officers regarding Chinese theories of medicine are 
interesting ; many others are curious. The remarkable divergence between some of those theories 
and those which are current among Western nations is no less striking than the approach which in 
other instances is manifest between them. 

An item of very great and suggestive importance is that, among articles of ' Materia Medica,' 
some of the most generally used at the present day have been so in China from very ancient times. 



XVI JNTRODUCTORY REMARKS. 

In other instances articles supposed in that country to have especial and potent properties enjoyed 
reputations precisely similar in our own country, down to a comparatively recent period. 

With a view to carry on, as it were, the lines of investigation indicated in the Eeports under 
notice, I have in some instances extended my analysis to works by other authors. In this way 
information has been added, and, I trust, the value of the general work enhanced. The chapters on 
Chinese Obstetrics, Epidemics, Famine, Chronology, etc., have been compiled in this manner. 

I regret that, by an oversight, the corrections made by Sir J. D. Hooker and Professor Oliver in 
the proof-sheets of the article on Chinese Materia Medica were not all submitted in those sent to 
the printer. ' Experts ' will at once detect in that article, as it appears in the present volume, the 
errors in question. Suffice it, therefore, that their existence is here noticed. 

Another source of regret is that not until too late to utilize its valuable materials did I obtain 
possession of ' Contributions towards the Materia Medica and Natural History of China,' by Frederick 
Porter Smith, M.B. (Triibner and Co., 1871.) In that volume is contained not only an extensive 
list of drugs used, but also numerous particulars of the highest interest in regard to many of the 
articles described. Should it become desirable to reproduce the article on Drugs, which forms a 
portion of the present volume, I shall hope to repair both the omissions now mentioned. 

25, Westbouene Square, London, W. 
May, 1884. 



EPITOME OF MEDICAL REPORTS. 



PART I. 

LOCAL CONDITIONS IN RELATION TO PUBLIC HEALTH. 

PEKING. 

Peking is situated in latitude 39° 52' 16" N., and longitude 116° 28' 51-" B. With the excep- 
tion of Kalgan and Newchwang, it is the most northern foreign-occupied place in 
China. It is divided into two parts : the northern^ or Tartar cityj the capital pro- 
perly so termed^ because the residence of the Court ; and the southern or Chinese city^ a walled 
suburb. The former is surrounded by a high and broad brick wall^ in which are nine gates, 
whence the name sometimes applied to it. The City of the Nine Gates. The capital is situated 
in the midst of a sandy plain, part of the great alluvial plain of Ohihli, having a range of hills to 
the north, and at a distance of about thirty miles. These hills may be said to separate China 
from Mongolia. To the west there is also a range of hills, spurs as it were, running south from 
the northern ranges, and distant from Peking about twelve miles. — (II. 73-76.) 

The plan of the city is well laid out. The great thoroughfares are 120 to 200 feet wide ; the 
lanes broad enough to allow of three carts abreast. The centre of the roadway is raised ; on 
either side are pits fi'om which the road is repaired. These pits are substitutes 

p T • ■ -I ■ m, 1 1 • 1 • TT • 1 T I'l"'! of *e City. 

tor drains m the rainy season. The streets are public latrines. Urinals do not 
exist. Filth and refuse of houses are thrown into the streets. No deodorant is used. Human 
manure is collected in large heaps outside the city, to be used as such. The men employed in 
carrying it appear healthy and strong, nor do they suffer from the atmosphere by Avhich they are 
surrounded. The fuel used in Peking is anthracite coal ; but the Chinese object to chimneys. 
Many deaths occur in consequence by asphyxia from carbonic acid. Among the upper classes 
the floors and hangs, or sleeping-places, are covered with square bricks. Both are heated from 
without. The construction of the houses is such that in summer they are well ventilated, but 
in winter not so. They are well lighted, two sides being almost quite composed of doors and 
windows, the latter consisting formerly of Corean paper, more recently of glass. — (VIII. 32.) 

The plain alluded to is for the most part under cultivation, two crops per annum being pro- 
duced ; thus, marshy land scarcely if at all exists. The ground is drained by means of the 
roads, which become also the courses of the minor streams. The soil is not very . 

... ^ , . , . . Drainage. 

compact or adhesive ; hence it rapidly absorbs heat, and also parts with it, a cir- 
cumstance which to some extent accounts for the extremes between summer and winter tempera- 
ture. The agricultural products are various and abundant. The ordinary cereals, legumes 

1 



^ EPITOME OF MEDICAL REPORTS. 

and fruits of Nortli China are extensively raised ; these include wheat, barley, maize, three kinds 
of millet, buckwheat, yams, sweet potatoes, beans, various kinds of cabbages, cucumbers, carrots, 
jigiicuUui'al Pro- turnips, radishes, egg plants, onions, celery, parsley, pepper, and spinach. Tobacco 
"''''■ and cotton are cultivated. The fruits in the order of their appearance in the market 

are apricots, cherries, plums, peaches, apples, pears, walnuts, grapes, persimmons [Dyosi^yros Tialn), 
chestnuts, ground-nuts (AracJiin), etc. Besides these, the jujube {Zkyphus vulgaris), the seeds of 
the lotus {Xelumbiinn speciosuvi), the salted seeds of the water-lemon, and salted beans are exten- 
sively eaten by natives. The principal tree is the hwcd shu {8opliora japonica). Others include 
the elm, poplar, oak, mulberry, willow, etc. — (II. 7o.) 

The population of Peking has greatly decreased during the present century. The mortality 
of this capital has not been affected by population in the same ratio as occurs in Western cities ; 
. over-crowding in our sense of the expression is unknown except in the House of 
Refuge in winter, and there a fearful mortality occurs. The habits of the people 
generally take them much into the open air ; hence their healthiness, surrounded as they are by 
insanitary conditions. The houses contain no water-closets j the kitchens no drains or sinks ; the 
thoroughfares are receptacles for all kinds of filth ; yet the very lowest houses are not destitute 
of pure air, water, and open spaces around them. Many of the houses, however, are flooded in 
the rainy season. Adverting to the 'general arrangement of the houses, on the whole they are a 
credit to the enlightenment of the people. 

With few exceptions extra-mural burial is insisted on; there are, however, no public ceme- 
teries except for eunuchs and for members of foreign nationalities. Every well-to-do family 
. possesses a private burial-ground, and the dead are interred at considerable depths 

— in this respect different from some places, as Tientsin and Shanghai, where the 
coffins are simply left on the surface of the owner's ground. In fact, China may be said to be a 
vast necropolis. The dead are often retained in the family houses for weeks and months, or even 
years ; a system most dangerous in seasons of epidemics, and especially of small-pox, cholera, or 
diphtheria. The bodies of the poorer classes are in the first place taken to mosques outside most 
of the gates, and thence, after a few days, to a vault in the Foundling Hospital, where they are 
retained until a considerable number of them has accumulated, when the whole are taken away 
and buried.— (IV. 29.) 

In regard to drainsj Peking, in 1871, stood unrivalled among the cities of the world. Their 

age, extent, former admirable adaptation, and present i-uinous condition, are all alike striking. 

^ . At the date mentioned, all the main streets had two lanJ^e sewers, one on each side. 

Drams. . « . . . o ^ j 

built of brick and covered with granite blocks or slabs. These sewers are about 
five feet high and three feet wide, with branches to all the houses. The water from them enters 
into the city moat, and thence flows into the Peiho. The water from the wells is collected in 
tanks, from which the streets are watered ; that from drains and ditches is also used for the same 
purpose. The process takes place about sundown, and then ' the filth from the cesspools and 
stagnant drains creates a new smell, to which foreign olfactory nerves have never before been 
subjected.'— (II. 71-5.) 

The chief water-supply comes from the Kwen-ming lake, near the Yuen-ming-yuen Gardens, 

and it is again supplied by springs in the neighbouring hill of Yii-chien.to the 

"Water-supply. , x, • , i-, n n i ■ r- , • 

west. It IS sweet, soft, and pure, and equal it not superior to the water of Loch 

Katrine. The supply is supplemented by aqueducts from the monasteries of 

Springs. Pi-yiin-sze and Wo-fo-sze, where two springs exist, the former being a sulphuretted 

hydrogen cold spring. In the north-west angle of the city a large water reservoir exists ; 



LOCAL CONDITIONS IN DELATION TO PUBLIC HEALTH. 3 

and channels extend in different directions. Before the advent of winter the west and south 
moats are flooded from the samo source, with a view of affording a sufficient supply of ice. The 
east, north, and north-east moats contained a considerable quantity of water, but, 
except in very wet seasons, the other moats were either dry, or contained filthy 
streams of sewage and surface-water. Ice-houses stand along the banks. Much ice is consumed 
during summer by the Chinese, to whom it is sold at the rate of eight pounds for a penny ; 
they also use it for cooling their rooms. In respect to wells, Peking is probably 
unsurpassed by any city in the world. They exist in almost every lane ; and in the 
great thoroughfares, four, five, or more may be met with within a mile. They are never exhausted. 
They are usually situated on alternate sides of the streets, and are for the most part surrounded 
by willows. Almost every house of any consequence also contains one or two wells. — (II. 74.) The 
wells in the eastern part of the city are mostly brackish, except in the neighbourhood of canals or 
running streams. The hard water on boiling deposits a large quantity of lime. On the western 
side the water is softer. The wells are usually about 30 feet deep j water drawn from them in 
summer is quite cold, and meat suspended in them remains fresh. In winter they never freeze. 
The Chinese use the sweet water for infusing tea ; they wash, or rather wipe, their hands 
and faces in warm water, and seldom drink that which is cold. Brackish water is used for all 
cooking purposes. At the wells in the streets man and beast may slake their thirst at any time 
during day or night. The attention of the Governors of Peking, and of the Ancient water- 
Emperors of China, from the days of Kublai Khan, a.d. 1280, to Kienlung, who supply, 
died in 1796, was much occupied with the water-supply; hence the elaborate system of water- 
courses throughout the city. Since the latter date, howeverj these have" been neglected, 
and are out of repair; the whole system of water-courses being (in 1871) in ruins and choked 
up with earth. — (II. 75.) 

In the Report for the half-year ending March, 1874, the excellence of the water-supply is again 
adverted to. For infusing tea and for drinking, water is brought from certain famous wells, and 
sold at a cheap rate. Here, as elsewhere, the Chinese use, -almost exclusively, 
boiled water ; and though the water contains a considerable deposit of lime, 
calculus is not known in Peking, nor do other bad effects arise from its use. — (VIII. 34.) 

The food of the Chinese in Peking is mixed, but vegetable diet, from its cheapness, prevails. 
The cow or ox being regarded semi-sacred, because used by the Emperor in sacrifice to the 
Supreme Being at the Temple of Heaven, little beef is eaten, and the slaughter of 
cattle is forbidden. Buddhists refrain from eating flesh meat of any kind. The 
chief animal meat used is mutton and pork ; and with regard to the latter, it is observed that, 
' It filthy feeding of pigs induced trichinae, the most disastrous effects would be seen in China, for 
pig life here (Peking), as elsewhere, is simply revolting.' The Pekingese usually eat two meals 
daily, composed chiefly or solely of rice, or flour and a little vegetable. The hours are regular 
and early. They study their health well in relation to food, clothing, season, climate, etc. 
Heavy dinners, with copious vinous potations, are unknown among them. Raw and salted or 
vinegared vegetables, unripe fruit, hot water, tea, confections, etc., are freely partaken of by all 
classes. 

As a rule, the Chinese are sober and temperate ; yet those of Peking consume no inconsider- 
able quantity of spirits. In winter especially, a small quantity of whisky is drunk 
at each meal. This sanishu is very coarse, and contains a large quantity of fusel oil. 
It is believed to give rise to an inveterate form of dyspepsia, named by them ye Jco, 
a form of disease in which the oesophagus becomes constricted just below the larynx, all food, 

1—2 



-i EriTOME OF MEDICAL EEPORTS. 

and even water, being rejected from that point. A.s ordinary beverages, tliey almost universally 
use liot water and hot tea during the cold mouths. In the hot season the beverages are tea 
and iced drinks, as the sivaii mi fang, a kind of acid rice-soup.— (11. 79.) 

Tobacco, unknown in or only in part used towards the close of the last dynasty, a.d. loC.8- 
Tobacco. 10 i4, is now nearly universally used both by men and women. The native tobacco 

is very mild, and probably few bad effects arise from its use. — (II. 79.) 

With regard to the habits of life of the native inhabitants of Peking, Dr. Dudgeon says that. 

Secrets' of Life. ' Leaving Opium out of our calculation, we may safely assert that the Chinese, on 

the whole, in regard to eating and drinking, clothing and habits generally, have 

found out the secrets of long and healthy life in tropical regions, namely, keeping cool, being 

moderate in diet, and cultivating tranquil habits of body and mind.' — (II. 80.) 

The clothes of the Chinese are generally of the most becoming and simple kinds. A painting 

or sculpture which exposed anything but the head, and perhaps the hands, would be set down as 

. barbarous and gross. In summer, a long cotton or silk robe is the chief part of the 

dress. In winter, wadded garments are in use among the poor ; among the higher 

classes furs of various values, according to degrees. They are destitute of shirts, flannels, and 

anti-cholera bandages. The Chinese put on or take off an additional robe as occasion requires. 

They use, in winter, shoes or boots padded with cotton. In summer, they wear straw hats ; in 
winter, tight-fitting wadded caps. Many expose their heads to the sun without hurt. 

The Pekingese resort much to public baths. Cold bathing is never practised by them ; they 
always bathe in tepid water, and it is to this circumstance, added to their temperate habits and 
non-use of flannel in summer, that the absence of prickly heat is assigned. The 
bath, however, generally consists in wiping the surface over with a wet towel. The 
Chinese dread the effects of water, especially cold water, when freely applied to the surface. It 
would be positively cruel to think of disarming the beggars of their ingrained dirt and grease by 
a bath, because in winter they would die from inability to resist the cold. The middle and upper 
classes have objections also, founded on their theory of the yumj and yiii, or the upper or 
heavenly, and lower or earthly, portions of the body. Many will wash the ujDper, but refuse to 
wash the lower, being afraid lest the lower vapour should ascend and injure the upper. The 
universal habit of shaving the head is a good one among a people inclined to dirty habits 
of body. 

With the exception of that of soldier, there is no trade or occupation particularly prejudicial 
to health. The people indulge in various gymnastics and games. 

The people retire early to rest, opium-smokers excepted. They do everything quietly and 
methodically ; they avoid hurry. — (II. 80.) 

According to the Eeport to 31st March, 1874, Hhe mode of life is quiet and non-exciting. 
There are no special precautions required in regard to san and malaria. Ague, until the late 
rainy seasons, was unknown ; sunstroke also is all but unknown. The account 
given of social life and manners is extremely favourable, and even attractive. 
There is a hill-retreat at convenient distance, to which foreigners resort in summer; and the 
general conditions of health are very favourable. The average length of missionary life there has 
been twenty-five to twenty-six years.' — (VIII. 36.) 

The term ' climate ' is in Chinese expressed by Fenj-shui — that is, ' air and water.' Otherwise 

the local Chinese expression for ' climate ' is ' water and earth '; also man is ' in 

more respects than one the mere expression of the soil on which he lives.' It is 

considei'cd that the local causes producing and influencing epidemic and endemic diseases are 



LOCAL CONDITIONS IN RELATION TO PUBLIC HEALTH. 5 

' endemic atmosphere^ water-supply^ social habits^ solar. influenceSj geological conditions, degree 
of cultivation of the soil, population, prevailing winds,' etc. — (II. 73.) 

At Peking, in 1871, unprecedented rain set in on Gtli July. From that date till 12th September, 
with short intervals, the rainfall continued, the quantity registered during the period being 36 
inches. Large portions of the city were submerged to a depth of several feet in 
some places. Houses were swept away, and in many instances people and animals 
drowned. In the half-year ending 30th September of that year the hottest days were May 31st, 
June 5th and 8th, the temperature in all equal, namely, 100° Fahr. ; the hottest nights, 22nd July 
and 3rd August, both 77° Fahr. The three coldest days, April 19th — there having been a fall of 
half an inch of snow, and also of rain on the previous day — and September IGtli and 17th, the 
temperature 58° Fahr. on each. The coldest nights were those of April 20th, the temperature 
32° Fahr. ; and of 26th September, 43° Fahr.— (III. 8.) 

From October to February north and north-west winds prevail ; from April to the end of 
September chiefly southerly, varying from south-east to south-west, although at intervals winds 
from east, north, and north-west occur. The latter is the coldest wind, coming as it does from 
the highlands of Central Asia, and over the steppes of Siberia and Mongolia. A severe blow 
from this direction in DecembBr will freeze the river in one night. 

In spring, dust-storms are of frequent occurrence, although in that period of 1872 they were 
fewer than usual. In summer, storms of dust, frequently also of thunder and rain, or even hail, 
are common ; these storms believed to originate in the desert of Gobi, and sometimes extending 
to Peking in the north and Shanghai in the south. 

The Peking climate includes the extremes of heat and cold — from 100° Fahr. and above it in 
summer, to zero and below it in winter. The seasons may be thus divided : Summer and winter, 
four months- each ; spring and autumn, two months each. The changes of temperatare are great 
and sudden, yet from the sandy nature of the surrounding plain the weather is generally agreeable 
and dry, and there being little rain and much sunshine, the climate is for the most part a pleasant 
one and healthy. The winter season is bracing and dry, the change from winter to spring 
very sudden. The fall of rain occurs almost exclusively in June, Jnly, August, and September ; 
from November to April hardly any rain falls. — (III. 35-6.) 

During the six months from April to September, 1873, the hottest day was June 29th. The 
thermometer marked 103° Fahr. ; a hot wind blew strongly. On the following day " 
the temperature attained a maximum of 102° Fahr., sinking at night to 79° Fahr. 
From the ILth to 18th July rain fell daily, the quantity in all 4jV inches. From July 29th to 
August 9th rain fell on every day except two ; the amount registered, 10 inches. — (VI. 19.) 

According to the Eeport to Slsfc March, 1874, the previous winter was mild; little snow fell. 
The Chinese predict an unhealthy season when such is the case, and it is a duty of ' the Dragon 
Throne ' to pray for snow. The hot season in ordinary years is described as 
lasting only six weeks, and during that time the thermometer is seldom above 100° 
Fahr. in the daytime, while the nights are 20° Fahr. cooler. The intensely cold weather is also of 
short duration, the thermometer seldom below — 3° Fahr. and— 5° Fahr. The prevailing wind is from 
north-west; the sky as a rule bright. There are few dull, foggy, or cloudy days, owing to the 
di'yness of the atmosphere, and the soil permitting little or no evaporation ; the heat is never oppres- 
sive. During the hottest times a blanket can be used as a covering. Moderately cold weather lasts 
about four months. Rainfall, except during the last three or four years, which have been unusually 
wet, never exceeds 26 inches per annum, in this respect resembling Germany. — (VIII. 29-35.) 
From 1st April to 30th September, 1874, the total rainfall for the period was 21 inches ; the 



G 



EPITOME OF MEDICAL REPOKTS. 



number of days on wliich it rained, 51. In 1873 there were over 34 inches of rain in 55 days. 
During the half-year now considered, the hottest day was June 21st, the only one on which, the 
thermometer reached 100° Fahr. The hottest night was that of July 23rd, when it stood at 
76° Fahr. The winter of 1874, although protracted, was not a severe one. It set in early and 
very sharp on 23rd November, the thermometer suddenly falling from 34° Fahr. on the previous 
night and J5° Fahr. by day, to 16° Fahr. at night and 31° Fahr. by day. The upper part of the 
Peiho became frozen over, and did not again open. This is the earliest closure of the upper 
reaches of the river that has been recorded in these Reports. The thermometer gradually rose 
again to 27° Fahr. at night and 40° Fahr. by day until 24th December, when it fell to 10° Fahr. 
at night and 28° Fahr. by day. During the last live days of December it varied between 3° Fahr. 
and 7° Fahr. at night, rising to 20° Fahr. during the day.— (IX. 33.) 

Adverting to the physical conditions of Peking already stated, the Report for April — 

September, 1372, has the remarks quoted as follows, namely : ' But the most remarkable thing is 

that with all our filth, dirt, and smells — and people in the West can form no notion 

of what they are, for they defy description — there is wonderful immunity from 

fevers. If bad smells alone created fevers, there ought to be no immunity from these diseases in 

Peking. The police or scavengers employed to water the streets ought to be the 

class most affected, whereas, leaving out the opium-smokers among them, they are 

the healthiest and most robust of our population. The beggars, a numerous class, sleep in the 

streets nearly all the year round, congregate in the very centres of pollution, and 

JjCGfffiirs 

even to some extent contest with the dogs priority of claim to the refuse of the 
dunghills. Still they survive and flourish, and most of them — at least, the strictly professional 
ones — look fat and sleek. To add to this picture of filth, we boast of no public 
latrines. The male portion of the inhabitants scpat in the streets after dark — very 
many, too, during the day — and that sometimes in the most crowded thoroughfares. One of our 
greatest nuisances is the removal of this filth in small barrows through the public streets at all 
times of the day. It is dried and stored in empty places, either within the city 
or immediately outside the gates. The most polluted places are generally the 
mouths of caves and waste places, or tumble-down, unoccupied shops or houses. A favourite 
place is the ruinous police-stations, which are so numerous in the public thoroughfares. Not- 
withstanding this revolting description, after an experience of eight years. Dr. Dudgeon was led 
to believe that the climate is not an unhealthy one.^ Then follows a foot-note to this effect : ' The 
sanitary legislation of Western cities is based upon the one idea that disaoreeable 

Western Standard. ■, Z, ■ -, -i n i • i i i m, 

and offensive odours are necessarily deleterious to health. The condition and 
mortality of Peking would seem rather to explode this belief. The removal of night-soil may be 
considered most destructive to health, yet here — there being no system for carrying off sewao-e or 
scouring drains — the entire night-soil of the city is transported during the day through the most 
crowded and sometimes narrow thoroughfares. We are obliged to pass certain localities at all 
times with closed nostrils, while hundreds of peoiDle continually live in and above these open cess- 
pools, and yet manage to look well and healthy. Many diseases prevail here, as in the West, 
without the agency of this reputed cause — noxious odours ; aud the causes exist at all times here 
without producing such diseases.-' — (IV. 41.) 

Adverting to a case of fyplKiid fever in his Report to 30th September, 1872, Dr. Dudo-eou 
Drains and wrote : ■■ It is not yot proved that the exhalations of drains, privies, and stagnant 
Typhoid. water do contain or disseminate this poison (namely, the " poison " of typhoid 
fever), or that througb such exhalations it can be absorbed into the system.' — (VI, 7.) 



LOCAL CONDITIONS IN EELATION TO PUBLIC HEALTH. / 

In the Report on Peking to 31st Marcli, 1874, the medical officer admits that the 'sanitary 
conditions ' of the capital are irremediable ; yet the accusation that, as a consequence, it is 
unhealthy, ' by no means follows.' The system of drainage is several hundred years old : two 
drains in all the great streets, and one in each lane, which drain into the moat. Many of them 
are broken down, and others are impervious j but still, although dirty, they fulfil their general 
object. There is a perpetual stream of pure water running through the moat on all sides of the 
city. Throughout the city and suburbs, there is only one place known to foreigners the odours 
of which are particularly offensive. The latrine system may be said to be on the dry-earth 
method.— (VIII. 30.) 

In his Report for the half-year ending September, 1872, the medical officer observes that 
among the native population the ratio of births and deaths is 1,000 of the former to 800 of the 
latter. Among the population generally. Dr. Dudgeon considers that the poorer 
classes breathe purer air and have better food than the corresponding' classes in 
London. With regard to foreigners, the average of 65 missionaries buried in the Portuguese 
cemetery, from 1810 to 1838, is 50 years; the average length of residence 24 years. The 
average age of 30 missionaries interred in the French cemetery, from 1 707 to 1868, is 
60 years ; the average length of residence 25 years. In more recent years the rate of mortality 
among Russians (4'0 per cent.) at Peking is said to be greater than of other foreigners, but the 
ratio is stated to be in accord with that of St. Petersburg. The British death-rate in Peking is 
that of England generally. Among French priests, and especially among Sisters of Mercy, 
the rate of mortality is great and appalling ; but, it is added, this is a result of the nature 
of the work they perform among the poor and the sick. Dr. Dudgeon observes also that, 
' although the sanitary condition of the city is so far from satisfactory, it is a matter of con- 
gratulation that the foreign population enjoys such an immunity from disease. This is all the 
more wonderful when we consider that wo live in the midst of a large city, and not in a 
healthy, clean, well-drained concession, apart from Chinese habitations and foul smells.' — 
(IV. 30-35.) 

Adverting to the rate of mortality among the thousand beggars who during winter remain in 
the Imperial Souse of Refuge (Yang chi yuen), Dr. Dudgeon states that it amounts to 40 to 60 
per month. In reference to prisons and prisoners, he writes that the mortality is 
excessive. Prisoners, however committed, let the charge against them be grave or 
light, or even false and unfounded, or at all events unproven, live, sleep, and perform their func- 
tions in one locality. It is specially made disgusting in order to drive them to extremes. Friends 
and relatives are not admitted with food or money without bribing the porters. Language fails 
to describe accurately the horrors of a Chinese prison. Suffice it to say that there is ever over- 
whelming mortality. — (IV. 32.) 

During the six months ending September, 1874, the health of the community was excellent. 
A few cases of dysentery and diarrhoea were considered due to sudden alternations of temperature 
during the rainy season, these being deemed preventible were due precautions taken pi-eTcntibio Dis- 
as regai'ds diet, clothing, and precautions against such alternations. — (IX. 21.) <"'^'^- 

In the first of the series of statistical Reports Dr. Dudgeon treated (pp. 114 et seq.) of the 
epidemics of small-pox and diphtheria which had visited Peking dui'ing the ten years preceding 
the end of 1871. In the Report now being considered he discusses the subject of former Epi- 
Cholera epidemics at that capital, but for the sake of continuity the points thus demies. 
adduced will be considered under the latter heading (which see). Unfortunately the first number 
is not forthcoming. 



o EPITOME OF MEDICAL REPORTS. 

In September and October, 1861, an epidemic of jaundice prevailed at Peking and the two 
Jiumdico. provinces westward of Chilili. In 1866 there occurred an epidemic of measles in 
Measles. spring ; and in 1868 typlms fever, wbich is seldom absent, raged with more than 
usual virulence. — (IV. 39.) 

Diarrhoea, which prevails in summer, is considered to be due in some measure to the use of 

unripe fruit, or the drinking of warm tea afterwards, which may have more to do 

Calculus^ with it than either cold water or air. Gravel and calculus are practically unknown. 

Neurafo-iii, etc. Rabies is extremely rare, though dogs abound, and are never muzzled. In 

winter neuralgia, rheumatism, anaesthesia, etc., are attributed to the coldness and 

dampness of the kangs, on which the Chinese recline during the day and sleep at night. These 

affections are most present in spring and autumn, when vicissitudes of temperature 

are greatest. Among the Budhists enthetic diseases are stated to be very prevalent. 

Worms, specially tape-worms, are remarkably frequent, so is dyspepsia. — (II. 75-78.) 

During the sis months ending September, 1871, a Kussian lady died of puerperal fever, a British 
Paer erai subject from typhus fever. Tever is the most fatal of the ailments to which foreign 
Typhus, residents are subject, and, after small-pox, is the most prevalent affection among the 

LowFeTev. Chinese. Numerous cases of low continued fever are seen yearly in summer. 
Diphtheria, although not epidemic, occurred throughout the six months; there were also numerous 
cases of ague. Carbuncles, at all times common among the Chinese, were not particularly so. — 
(III. 7.) Cases of heat apoplexy in the hot season are unknown. During winter frost- 
bite occasionally attacks the lowest and most unhealthy of the beggar class. Prickly 
diseases. heat is common during summer. Thoracic diseases prevail over abdominal, 

although from the climate partaking of the character of hot and cold, the diseases peculiar to both 
are met with. Ague, as already mentioned, is not met with, but various affections of the lungs 
occur. Mumps and tonsilitis ai-e not uncommon. — (III. 37-42.) 

In the spring season of 1871 there was reported to be a considerable tendency, both among 

„, . , , foreigners and natives, to erysipelas, mumps, bronchitis, and sore throat generally. 

— (III. 7.) In that season and autumn, but especially the latter, cases of jaundice 

occur. Certain diseases of the lungs occur in spring, autumn, and winter. Phthisis, asthma, 

... bronchitis, and haDmoptysis prevail pretty extensively, although the latter affection, 

in very many cases, is unattended with fatal results. Towards the end of Ma,rch, 

and in April, sore throat, mumps, and tonsilitis are not uncommon. — (IV. 39.) As a result of sudden 

changes of temperature, occasionally experienced during or after rain, diarrhoea 

X>iarrlj03a, etc. V.f.i,n.Tn ttt /ttt ti \ \ i m 

and dysentery affect both children and adults. — (VI. /.) Ague, up till now unknown, 

prevailed extensively during the summer of 1872 ; it gave way before the approach of the cold 

weather in December. Small-pox seems to be seldom absent from the capital. In February, 

1873, diphtheria prevailed among the Chinese population. In spring and summer, 

ip cna. ^^^^ becomes very prevalent, so do other skin diseases, particularly among the lower 

classes, due in part to season, and in part to personal dirt. — (YI. 11-14.) 

During the winter of 1873 and 1874, small-pox ' as usual prevailed.' A few cases of dijohtheria 

also occurred ; also of low fever. Ague prevailed ' with great force ' till the end of 

Small.pox. j3ecember.— (VIII. 29.) In the spring of 1875, there was ' as usual' a good deal 

of diphtheria, and, later on, fever; but neither of these diseases attacked foreigner?. 

In spring, openings are made here and there in the drains. The effluvia from 

these open drains are cited by the Chinese themselves as causes of these affections. — 

(IX. 22.) 



LOCAL CO>fDITIONS IN RELATION TO PUBLIC HEALTH. 



TIENTSIN. 

With regard to the British settlement at Tientsin on the right bank of the river Peiho^ in 
latitude oQ" 0' N., longitude 117° 30' E., the followiner particulars are contained ^ . . 

" ^ Position. 

m the Report before us : 

Throughout the winter of 1872-3^ the water-supply of Tientsin was all that could be desired. 
During the other months of the year^ the river being full of boatSj it contains a 
certain proportion of sewage matter. Still, it is not polluted to a dangerous extent ; 
and if treated with alum^ and carefully filtered^ it is both palatable and wholesome. — (V. 21..) 

]\Iany of the places of public resort are on the river-bank, and the filth from the foreign and 
native shipping passes the foreign concession^ contaminating the water-supply. The settlements 
are so close to the native city that the water has no time to get purified. It therefore requii'es to 
be manipulated in various ways, passed through filters, allowed to settle, or boiled, or the 
organic matter is precipitated by chemical agents, alum being in most common use. — (VIII. 31.) 

The first notice in regard to the health history of Tientsin, which occurs in the Reports before 
us, has reference to the half-yearly period ending olst March, 1873. During that 
period the health of the foreign community was very good. One child died of 
diphtheria, the first case of the kind seen among foreigners, although the disease is occasionally 
but rarely seen among the Chinese inhabitants. In 1871-2, the settlement was 
inundated. During the winter, 1872-7o, the health of the foreign community was ''' 
not as a consequence affected, although the native Chinese suffered from remittent and intermittent 
types of fever. , The immunity from these enjoyed by foreigners is assigned to the 
circumstance that their settlement was elevated and well drained. — (V. 23.) For 
the half-year ending 30th September of the latter year, the health of the foreign community con- 
tinued good ; so also that of the shipping. This also notwithstanding a very hot and rainy 
season, with a fresh inundation of the surrounding country. — (VI. 52.) During the half-year 
ending 30th September, 1874, the health of the foreign community still was good, notwithstanding 
the swampy and generally unhealthy state of the surrounding country. — (VIII. 40.) In that 
ending 31st March, 1876, the health of the foreign community was good. — (XL 47.) To 30th 
September of the same year that community ' as usual' enjoyed good health; but on board the 
men-of-war in the river dysentery and remittent fever prevailed severely.^ — (XII. 48.) Prom 
April to September, 1878, notwithstanding a very mild and dry hot season, the health of the 
community was not at all good. — (XIV, 66.) In the months of October, November, and December, 
1878, the residents, both native and foreign, suffered severely from various forms of disease, 
notably typhus fever, small-pox, and affections of the lungs. The general health of the settlement 
improved considerably after the heavy continual rains; dysentery, diarrhoea, and ague became 
less frequent in recurrence. This improvement was, by Dr. Irwin, considered due to improve- 
ment to the marshy, grave-dotted plain at the back of the settlement being inundated, and the 
numerous large pits therein filled with water. — (VII. 33-35.) During the year ending 31st March, 
1880, the health of foreigners was particularly good. Considerable improvements were made 
in the course of that year in the state of the roads and drainage connected with the settlement. — • 
(XIX. 5.) 

According to the Report to 30th September, IS 73, thi^ee cases of dysentery occurred at 
Tientsin during the six-monthly period referred to. As on previous occasions, that place was 



10 EPITOME OF MEDICAL REPORT.S. 

remarkably frco from enthetio disease. Intermittent aud remittent fever occurred, the latter 
Diseases. having appeared only since the date of the inundations in 1871.- — (VI. 52.) In- 
termittent fever of the quotidian type was very prevalent during the six months 
ending SOfch September, 1874. With the exception of a few, the cases of it were very amenable 
to treatment.— (\''III. 40.) In the half-year ending ;3lst March, 1876, a severe form of 
diphtheria prevailed among the native community. — (XI. 47.) In that succeeding, namely 
to ;30th September of the same year, dysentery affected sailors ; remittent fever, chiefly childi-en. 
Some cases of diphtheria also occurred. — (XII. 48.) From April to September, 1877, cases of 
remittent fever, dysentery, and bowel derangement were very frequent; choleraic diarrhoea, 
chronic diarrhoea, and mesenteric disease occurred among children. In spring and early summer, 
typhus, typhoid, and relapsing fevers raged among the native population; in August and 
September, cholera of a fatal type. — (XIY. OG.) In the three last months of the year 18/8, 
typhus fever and small-pox prevailed, natives aud foreigners suffering alike. The causes of 
ty2ohus were not far to seek : a famine-stricken population of refugees from the neighbouring 
provinces, their physical condition the worst possible, scarcity of food, insufficient clothing;, 
overcrowding, dirt, very rigorous winter, and mental depression. It is believed that of 80,000 
refugees who sought shelter during the previous winter, barely 10,0U0 were alive at the end 
of ]\Iay. The streets were filled with sick and starving ; the bodies of the dead lay sometimes 
for two days before they were buried by order of the authorities. In the river Peiho bodies 
were constantly floating down. During March, 1870, most of the children in the settlement 
suffered from an epidemic catarrhal fever with croupy symi^toms. — (XVII. oo.) In the autumn 
months of that year, diarrha:a, dysentery, and intermittent fever were the most prevalent 
diseases. During the months of October, November, and December, whooping-cough attacked 
some children. Throughout the year ending 31st March, 1880, entozoa of different species, 
more especially tfPnia and lumbrici, were present, the former in foreigners, the latter in natives. 
— (XIX. 5.) 

XBWCinVANG. 

The geographical position of Newchwang is latitude 10° 05' N., longitude 122° E. Unfortu- 
nately the first portion of the Report on this settlement by Dr. Watson is 
opogiap y. ^^j_ available. From the second portion the following particulars are taken : 

Besides the advantages of a seaside resort at Kai-chu, more particularly detailed under the 
head of Gliinuti, there are numerous inland places which would repay a month's 
residence to persons at Newchwang, or to those coming from southern ports in 

search of health. One such place is situated on the terraced sides of C'hien-shan, on which 

are erected several Buddhist and Taoist monasteries. It is distant about 80 to 90 miles 

from the Treaty Port. For many miles immediately around Newchwang, the country 

is very uninteresting. It is beyond these limits that it becomes full of beauty, and endowed 

with a genial summer temperature. — (III. 10-1-5.) 

In the Report, not now available, Dr. Watson mentioned the unsatisfactory state of tho 

drainage, and generally faulty construction of the houses iu this settlement. According to that 
to oOth September, 1871, httle or nothing had, up to that date, been done to 
rcctif}^ the former state of matters concerning drainage. In regard to the houses 

howevei', several new and healthy ones had been erected, i-aised from the ground, and M'ith 

results beneficial to the health of their occupants. — (VIII. D-lO.) 



LOCAL CONDJTIONS IN RELATION TO PUBLIC HEALTH. 11 

During tlie summer of 1878, diarrhoea among the foreign residents was considered to be due to 
impure water. Almost all the drinking water is obtained from surface ponds^ and is frequently used 
without being either boiled or filtered. Situated as this settlement is on the bank 
of a great river, it would be matter of little difficulty to obtaia ample supplies '''°''' 

of pure water if the foreign community was a large one ; but as the Chinese will not under- 
take the necessary work for their own benefit, it is impossible for the few foreigners to do 
so. They have to content themselves, therefore, by taking water from the ponds above referred 
to, or by sending a few miles into the country, where good spriags are to be found, ol' by usino- 
the water from the river. — (XVII. 8.) 

The people of the province of Newchwang are true Chinese^ notwithstanding that a consider- 
able number of Manchu villages are scattered over it. The chief occupations of the 
people are agriculture and trades connected therewith. Some also are employed as "^ °'^^'^' 
sailors, others as carters or waggon-men. They are sober and industrious ; they marry young_ 
They are physically well developed and powerful; are capable of great endurance. There are 
few beggars ; their food is extremely simple, cheap, and nourishing. The great 
majority live principally on millet, a grain which seems to possess all the essential 
elements of nutrition. It is simply boiled in water, and is very of ten eaten alone; oris mixed 
with vegetables^ mutton, fowl, bacon, or fish. The rich eat rice in place of millet. Beef is not 
much eaten, but vegetables, such as cabbage, carrots, turnips, etc.^ are held in great repute by 
rich and jjoor alike. All who can afford to do so drink a rather coarse spirit manufactured from 
millet (shamshu) ; they take it sparingly, and it is seldom that an intoxicated native is seen. 
Tobacco is smoked by men, women, and children. — (III. 12.) Opium-smoking, although far 
from general, is on the increase. Dr. "Watson notices the severity of injury the Chinese can 
sustain, and subsequently recover from, with a fair degree of health and strength ; a circumstance 
considered due to the simple diet of the common people, and to the phlegmatic temperament of 
the race. — (XII. :32.) 

In the months of April and May, 1871, the weather was more than usually boisterous, and it 
was a rare occurrence at Newchwang for the residents to enjoy a day of perfectly 
calm weather. The spring was in other respects pleasant. The summer months 
were remarkably cool, and by the middle of September warm clothing had to be worn; stoves 
also had to be set up — that is, a month before the usual time for so doing. During the months of 
June, July^ and first half of September, on a few occasions the temperature in the shade and out 
of doors stood at or about 02° Fahr.^ notwithstanding their general coolness. Within doors the 
maximum registered was 86° Fahr. Dr. Watson writes : ' The climate of the summer months is 
in this province very healthy. Such a climate in a pleasant country would be a boon to foreigners 
in China, oppressed by the trying summers of the southern ports. From Kai-chu, dis- 
tant 30 miles from Newchwang to Tower Hill, there is a long line of sandy beach, 
interrupted occasionally by massive rocks, worn by the sea into caves and boulders. At a bungalow, 
built upon one of these rocks facing the sea, and 100 feet above its level, the day temperature 
from July to September was 84° Fahr., the night temperature 74° Fahr. At Kai-chu good sea- 
bathing is to be had. Hills in the neighbourhood may easily be climbed ; their sides are wooded ; 
villao'es are dotted at intervals, a,nd in places handsome plantations. During the months from 
June to September, both inclusive, the climate at the Kai-chu beach is not surpassed by any in 
the world. The exceptional dryness is moderated by the sea breeze and occasional showers. 
The air never feels damp for more than a few hours at a time, and that at long intervals. The 

2—2 



12 EPITOME OF MEDICAL REPORTS. 

TOorniug air is exLilarfitiiig; the cool evenings sootlie and refresh tlie weak; sleep requires no 
wooing; it is followed by increased strength and energy.— (III. 10-14) 

At Newchwang the month of October is in many respects the healthiest and pleasantcst of 
the year. The other five months of the half-year ending Slst March, 1872, constituted the winter 
season. During the period thus embraced the winter was more than usually cold, dry, and 
dusty, men and animals suffering severely from drought, horses and mules especially. In the 
month of January, 1872, the temperature fell every night below zero, descending on the 22nd to 
— 11.° Fahr. During the winter great dust-storms were very frequent, the river opposite the 
settlement was frozen over on 20th December, and the ice broke up on the 12th j\Iarclr. The 
prevailing winds were N.E. and N.W. On Slst March a few masses of ice still floated down the 
river, although already the sun was powerful. — (III. 16-18.) The summer of 1872 was unusually hot. 
For three weeks the mercury was often as high as SS' Fahr., and on two occasions 95' Fahr. The 
winter having been remarkably cold, the high temperature of the half-year immediately following 
was deemed noteworthy. Eain fell on thirty-eight days, the quantity above the average. The pre- 
vailing winds were less boisterous than they usually are in the same period of the year. — (IV. 27.) 
The summers of 187-'j and 1874 were distinguished by an unusual C[uantity of rain, although the 
number of rainy days was not greater than in the average of years. This great and sometimes 
sudden rainfall inundated the neighbouring country. When v/inter came the water was frozen in 
the earth, and thus remained till spring. The severe frost of winter rends the ground into 
fissures, some of which extend to three and four feet beneath the surface. Thus, with the heat 
and rains of spring and summer, the district from the foreign settlement to the mountain-range 
became one great swamp. As a result of these conditions, the natives who farmed the plain 
alluded to suffered severely; the rich were impoverished ; the poor reduced to destitution; great 
sickness prevailed — and those who had not food helped themselves as best they could. Daring the 
summer of 1871, comparatively few Chinese starved; many had insufficient food, and a depressed 
state of health prevailed, due in part to the unhealthy condition of the country, and in jDart to in- 
sufficient and bad food. There was, however, no increase of mortality in the latter season ; but in 
the preceding winter many deaths occurred from cold and hunger. — (VIII. 7.) 

In his Report fur the two years ended oOth September, l87(i. Dr. Watson wrote: 'The 
period now under review has witnessed a return of the climate with which we have usually 
associated this region.' That is, the summers have been, as formerly, dry, the winds strong 
and frequent, the skies clear, the air bracing; while the general result has been that the 
natural stimulating character of the climate has replaced the dejn-essing influences which he 
pointed out as characteristic of the summers of 1873 and 1874. The summers of 1875 and 187G 
were remarkable for excessive drought. The winter of 1875, he witnessed a heavier fall of snow 
than is common ; the air was rendered somewhat less irritant than is usual, in consequence of 
the dust canted by the great cart traffic being thus laid. — (XII. 28.) 

During the summer of 1877, the climate was mild, the atmosphere less clear and bracing 
than usual, the rainfall small in quantity, if more frequent than is generally the case. The 
season was favourable to vegetable life, and in an unusual degree to foreigners, as instead of 
continued glare, the sky was often shrouded by clouds. The winter and summer temperature 
was each exceptional during the year ending March, 1878. In the former the cold was less 
severe ; in the latter there was less heat than in ordinary years. Ice first appeared in the river 
on 21st November; on 17th December it was completely frozen over, and on 23rd horses and 
carts were borne by it safely. On 10th March it began to break up.— (XV. 28-32.) 

Adverting to the peculiarities of the climate of this settlement, Dr. Watson writes : ' It is 



LOCAL CONDITIONS IN RELATION TO PUBLIC HEALTH. 13 

somewhafc remarkable that iu a climate sucli as this neighbourhood enjoys, where we have in 
summer for two months very hot weather, and in winter five months of great cold, and in both 
seasons sudden changes of temperature, neuralgia should, comparatively speaking, be rare. 
This immunity is partly explained by the dryness of the air, and by the fact that foreigners 
who venture to settle so far north are, as a rule, of robust constitutions.'' — (XVII. 10.) During the 
year ending 31st March, 1880, the climate was an average one. The first half of spring 
extremely boisterous ; the latter half, and the whole of summer, pleasantly free from gales, 
' and from those strong winds, little less than gales, which rendered animal and vegetable life in 
April, and some days in May, a hard fight.' There was more than the usual amount of rain ; 
the crops were good. The winter was mild, although one or two days were exceptionally cold. 
It is often remarked by delicate residents how much better they bear the cold of this some- 
what Arctic region than that of Shanghai. — (XIX. 1.) During the year ended 31st March, 1881, 
the climate was drier, spring less boisterous, the advent of autumn earlier, winter more sudden 
in its occurrence, and colder than in some recent years. The summer rainfall was less than usual, 
but no increase of sickness occurred in consequence. The highest temperature registered, 
namely 91° Fahr., was on the 4th of August; the lowest, 9° Fahr., on the 18th January. On 31st 
of March the river was still crowded with floating ice. — (XXI. 37-41.) 

During the half-year ending 30th September, 1871, the Chinese population enjoyed an im- 
munity from contagious fevers. In other respects they were tolerably healthy, 
although they suffered to some extent from respiratory ailments, due, in a less 
degree than among foreigners, to the exceptionally boisterous character of the spring. A great 
deal of poverty during the previous winter, and failure of trade during summer, also aided in 
the causation of disease. — (III. 12-17.) During the succeeding winter the health of the foreign 
community was fairly good. In the half-year ending 30th September, 1872, the warm summer, 
if the cause of an increased amount of sickness among foreigners, did not similarly affect the 
Chinese. The latter ' enjoyed an immunity from disease which, considering their indifference 
to healthy conditions, is very reoiarkable.' — (lY. 28.) The summer of 1873 and 1874 having 
been unusually rainy, and agricultural produce scarce, the native population suffered from rheu- 
matism, ague, and various forms of dyspepsia. The state of drainage of the settlement remained 
unsatisfactory ; much stagnant water existed, and to these conditions the medical officer assigned 
the prevalence of malarial disease. Improved residences for foreigners were being erected ; and 
as an example of the benefit to health accruing therefrom, a case is mentioned in which an attack 
of ague ceased immediately on removal of its subject from an inferior house to a good one. In 
the winter between those years, the health of the foreign community was good, there being only 
the ordinary cases of acute bronchitis, catarrh, etc. The Chinese, except such as were badly 
housed, as before enjoyed good health. — (VIII. 7-9.) 

In the two years ended September, 1876, although the summer heat on both occasions was 
unusually great, it was, as a rule, better borne by the residents than during some which were 
distinctly milder. The general health of foreigners and well-to-do Chinese was quite up to the 
average. — (XII. 28.) During the year ending 31st March, 1878, the health of foreigners and 
Chinese was less satisfactory than it had been in former years. As a consequence of the still 
prevailing distress among the native jjopulation, unburied bodies lay along the streets and roads_ 
The drains which intersect the town were filled during the dry season with refuse ; they were not 
cleaned by the light rains which subsequently fell, the result being extreme offensiveness from 
decomposing matters. The winter climate is a good one to persons who are in robust health; it 
is, however, trying to those whose health is impaired, particularly such as have a tendency 



14 KriTOME OP MEDICAL RErORTS. 

to pulmonary or cardiac ailaients. Among the Roman Catholic ' Sisters ' the rates of sickness and 
mortality were great. Among the causes were assigned the habits of that religious 
communitj', including privation, cold^ short and interrupted rest, besides their 
attendance upon sick Chinese residing in insanitary houses. They were thus more heavily 
affected by any depressing cause iu action than lay members of the community. Although in the 
month of October they moved into improved quarters, with improved hygienic conditions, yet 
in December several cases of fever, some with the character of typhus, occurred among them. 
No sooner were they settled in their new house, the weather at the time being changeable, cold, 
and damp, than nearly all of them suffered from pulmonary catarrh, while two of the most 
delicate of their number were prostiated with inflammation of the lungs and rheumatic fever. — 
(XV. 28-o0.) Daring the year ending March, 1870, neither in the winter nor summer months was 
there much -sickness among the foreign residents. The year was a prosperous one, and the mass 
of the people had abundance of employment and of the requirements for life. The recent years of 
scarcity had, however, produced a lai'ge number of beggars, and a largo number of native female 
children were allowed to die on the streets. A number of cases of suicide by women occurred, 
the means employed for the purpose being opium. But the people, as a whole, were well off, and 
eminently free from serious sickness ; they were well fed, moderately worked, and living as they 
do in a simjDle life in a good climate, they were healthy. — (XVII. 8.) 

Daring the year ending olst JMarch, 1880, the crops were abundant; the people had a 
sufficiency of food, and they were free from serious disease. The general health of the foreign 
community was good. In the twelve months no case of serious illness occurred in ' the little 
colony of Roman Catholic Sisters (ten in number) who for several years back have laboured 
at this port.' Several of them were on the sick-list, but all the cases were of a chronic character^ 
and were referable to constitutional weakness or over-work. — (XIX. 1-0.) The summer of 18S0 
was healthy alike to Chinese and foreigners ; only in young children some cases of diarrhoea 
occurred. The succeeding winter was very unhealthy as regards the latter, almost every foreign 
resident having suffered, some severely. Among the Chinese there was only the ordinary amount 
of sickness. The Chinese are crowded together, and depend upon rain as a means of clearing 
their drains and removing their filth ; the European community live in large compounds, in 
comfortable houses far apart from each other, have no drains, and all noxious matters removed 
at short intervals. ' Our circumstances, as compared with the Chinese in a sanitary point of 
view, are extremely good, and yet our little settlement had a much higher percentage of 
sickness than the native town during winter. This is the opposite of what, in the past, has 
been our experience in summer or winter. During the cholera epidemic hundreds of Chinese 
died, while no foreign resident suffered from the disease. Small-pox and other fevers have in 
the past been common among the Chinese and unknown among the European community. This 
year the tables are turned, and from what cause Dr. Watson cannot discover. We had an 
epidemic of quinsy, and a considerable number of cases of measles, besides individual cases 
of scarlet fever and typhus.' — (XXL ;J7.) 

During the spring mouths of 1871, inflamed throats (tonsilitis), bronchitis, and pulmonic 
affections prevailed, especially among children and young persons. These affections prevailed to 
an unusual extent in April and May, in consequence of the high winds and dust. 
Relapses also were frequent in the attacks so long as the boisterous weather 
continued. In the summer months dysentery and diarrhoea were of frequent occurrence. The 
other most prevalent diseases were rheumatic affections, neuralgia, etc. Among the natives 
many cases of scrofula and of sluggish ulcers were met with. Diseases of nutrition also were very 



LOCAL CONDITIONS IN EELATION TO PUBLIC HEALTH. 15 

frequoufc. During the winter following, gi'anular inflammation of tlie eyelids was very 

frequent, being attributed to the extreme prevalence of dust during that period. The throat 

affection already noticed continued also to prevail during the winter of that year, and the larger 

portion of the foreign community suffei'ed more or less severely from catarrh. — (III. 10.) 

Dr. Watson considers that the winter climate of this place is unsuited for'^p'atients suifering from 

organic disease of the heart and lungs. — (V. 47.) In the month of April, 1872, a solitary case of 

measles occurred in the Custom House. A case of small-pox on board ship from Shanghai 

entered the harbour. During the summer of that year, diarrhoea, colic, and dysentery were the 

most prevalent diseases, the two former being of unusual severity. — (IV. 27.) In the winter of 

1873, children suffered more than usual from diarrhoea; adults from rheumatism and neuralgia. 

Many of the poor died in the streets from cold and hunger. Foreign residents subscribed to 

meet the condition to which many natives were reduced. Shortly afterwards a Chinese guild 

opened soup-kitchens, and at these places, during three months, 1,500 persons had one 

meal of boiled millet daily, ' and ib was remarkable how healthy these men and women looked 

after their restricted diet.' In the summer of 1871, intermittent fever appeared for the first time 

among foreigners. The first case occurred in June, and was followed by other cases, the type of 

disease being almost universally tertian. Many persons suffered also from obscure nervous 

complaints, general iiudai^c, with enlargement of the liver and impaired digestion, all considered 

to be due to malaria. — (VIII. 7.) 

In the summers of 1875 and 187G, isolated cases of cholera, measles, and scarlet fever occurred 
among the foreign community ; ' Chinese measles ' was very common. In the native town severe 
diarrho3a and cholera were reported to have appeared. — (XII. 28.) During the year ending March, 
1878, there was a great deal of low fever of no very distinct type, diarrhea, and many ailments due 
to the absence of proper food among the Chinese. During the month of July, 1877, a large 
number of natives suffered from diarrhoea. Ou the 2Gth of that month cholera appeared. The 
disease continued to increase till the end of August, after which it decreased, and by the middle of 
October had quite disappeared. Among the Roman Catholic ' Sisters ' several cases 
of fever occurred during winter, this notwithstanding that they were living in im- 
proved quarters as compared with those they previously occupied. Dr. Watson gives particulars 
in regard to their manner of life, and the predisposition to illness incidental thereto. — (XV. 28-o2.) 
In the summer of 1878, simple diarrhoea prevailed among the foreign residents, it being con- 
sidered due to water of inferior quality.— (XVII. 8.) During the year ending 31st March, ]880, 
the Chinese in the native town suffered slightly from small-pox, more severely at a large trading 
port some 30 miles farther up the river. A somewhat larger number of cases of febricula and 
of typhus-like fever also occurred among them. — (XIX. 1.) 



CIIEFOO. 

The Port of Chefoo (Ventai) is situated in lat. 37° 35' 5G" N., and long. 121° 22' 35" E. 
A series of picturesque hills take the form of an amphitheatre, commencing in the east at 
Knob Point, circling towards the south, and dipping westward to the sea. A 

-^^"^ " ' ° ' i. L ^ • 1 ,1 f/ir i: Topography. 

sandy spit, 1 or 5 miles in length, connects that range with the Ohetoo 
Bluff.' Thus the bay is due to the bluff on the north, the sandy spit on the west, the shore on 
which stands the town being on the south. Behind the foreign settlement, a gorgeously 
cultivated plateau extends to the base of the hills, forming a vista at once pleasing to the eye and 



16 EPITOME OF MEDICAL REPOllTS. 

suggestive of health to the spectator. At a little distance from the settlement there are 

sulphurous springs^ regarding which see 'Mineral Waters.' — (III. o7-ll.) 

^^-— J[n^e Report for the year ending March, 1872, the medical officer records the absence of 

drainage. He, writes : 'At the same time I must confess that this condition appears to exercise 

no inj'cUiious influence over the sanitary state.' This absence of injurious result 

oDseivancy. ^^^^ ^^ accounted for by the great porosity of the soil ; secondly, by the prevalence 

of high winds, acting as 'diluents;' and thirdly, by the refuse matter being collected for 

agricultural purposes. — (III. 40.) In 1873, Drs. Carmichael and Myers 'had to call the 

attention of householders to the unhealthy condition of their premises, but their suggestions 

did not always meet with the response they could have desired.' Yet the community at Chefoo 

was not less advanced in sanitary practice than other communities in China. — (VIII. 50.) 

According to the Eeport for the half-year ending olst March, 1878, conservancy was ignored by 

most of the householders. Were this better attended to, the reporter believes Chefoo would be 

much resorted to as a sanatorium. — (XV. 20.) 

In March, 1872, the water-supply was very unsatisfactory. Nearly all the plain surrounding 

the town is one great graveyard, through which the water must percolate into the wells ; 

and besides this, the extremely filthy and objectionable habits of the natives 

"Wiitcr 

lead to still further contamination of the water by matters in themselves most 
objectionable. And j'et it is stated that persons long resident here appear to suffer but little 
inconvenience from this state of affairs, although iu the case of crews of ships using the 
water, they almost immediately became attacked by diarrhoja, although the affection itself 
is not in such an emergency either severe or of long duration. — (III. 41.) 

In 1872, the climate of Chefoo was described as mild and agreeable, moderately dry, with suffi- 
cient ozone to render it nearly perfect. The temperature is not excessive in summer ; 
in winter the cold is severe, but its severity does not appear to injure even delicate 
persons. During the latter season there are few atmospheric changes; and this, added to the 
dryness of the air, adds to the advantages of the climate. In early spring, feverish catarrh, 
similar to influenza, prevailed ; but from May till November the climate was extolled as being 
tonic and bracing — to invalids suffering from hepatic or renal affections, dyspeptic attacks, or loss 
of tone, the climate is considered to be peculiarly advantageous. As a sanitary resort few places 
in the world can enter into competition with this favoured port, which, as a residence 
for the Western foreigner. Dr. Myers defies any other country, remote from the land 
of his nativity, to present a locality possessing such a happy blending of all the climatic conditions 
essential to the preservation of health and vigour. — (111.37-42.) The temperature during the summer 
of 1872 was milder than that of the same season of the preceding year. The weather during the 
winter was variable, the changes sudden.- — (V. 15.) In the early part of summer there was a 
large influx of visitors from the south, affected with malarious remittent fever, and intestinal 
catarrh. The former speedily yielded to change of climate, but the latter was not so easily con- 
trolled, frequently requiring a protracted residence and great care befoi'e improvement was 
observed. Dr. Myers noted the rapid convalescence from fevers, intestinal and hepatic affections 
among patients who came to Chefoo early iu the season. Later on, in consequence of the 
frequent rains, the change was not found to be so great or so beneficial. But patients, aj^parently 
seriously ill, who resort to this place before July, make surprisingly rapid recoveries, which the 
medical officers attribute to the direct influence of the climate. They add, that these remarks 
have more especially reference to patients from Shanghai. — (A^II. 50.) During the summer of 
1876 great heat prevailed, accompanied by drought. Cereal crops completely failed; those of 



LOCAL CONDITIONS IN RELATION TO PUBLIC HEALTH. 17 

sweet potatoes were plentiful. In some districts good crops promised, but tliese were consumed 
by locusts; a caterpillar also destroyed much of the sorghum. The coldest day was 2.jtli 
January. The highest temperature, namely 10o° Pahr., on the 11th and oOtli of July. On 1st 
of May the temperature rose rapidly to 90° Fahr. It was 101° Fahr. on the 29th, and 100° Fahr. 
6th July. On the 31st August it was 100° Fahr. Except during August and September, tho 
rainfall was insignificant. There was no heavy fall of snow during the winter. Some days 
upon which neither rain nor snow fell were cloudy or stormy, but for the most part they were 
clear, bright, and dry, such as are only met with elsewhere in places like Central Asia or in 
certain districts on the Pacific coast of America. Eain or snow fell on 35 days, leaving 330 
days of ' fine weather.' — (XII. 42.) During the winter of 1877-78, the unusual occurrence took 
place of the harbour being, at different periods, completely icebound. The floes extended for 
miles in an almost unbroken mass. But as soon as a breeze arose from the north or east, large 
masses were driven shoreward. January and February were the coldest months ; on 19 days 
in the former the thermometer stood below 20° Fahr. ; but, there being an absence of much wind, 
the cold was not severely felt. — (XV. 17.) In the summer of 1878, an unusual amount of rain 
fell. During April, May, June, and September, the temperature was much the same as the 
corresponding period of the previous year ; but the months of July and August were several 
degrees warmer, having exceeded 90° Fahr. on 19 days in these two months. In July, hot and 
oppi'essive winds from the south at times prevailed; during their continuance the temperature 
rose to 103° Fahr., but speedily subsided to 88° Fahr. Thunderstorms were of frequent occur- 
rence, and served to moderate the temperature. — (XVI. 14.) In the winter of 1878-79, frequent 
violent storms occurred, attended by a number of disasters to ships in harbour and along the 
adjoining coast. — (XVII. 14.) The summer of the latter year was unusually rainy. High tem- 
perature occurred for a few days now and then, but the settlement was never without a delicious 
breeze, rendering the sensations cool, even with the thermometer at 95° Fahr. — (XVIII. 71.) In 
the half-year ending 31st March, 1880, the winter season was comparatively mild. In the latter 
part of it, or early spring, many persons remarked a wonderful development of electricity in 
the air. During the operation of dressing the hair, in some instances, sparks of electricity 
were visible ; ' but it has not yet been determined if an electrical condition of the atmosphere 
has any effect upon health or disease.' The seasons of winter and spring were both clear 
and bracing. — (XIX. 31.) The summer of 1880 was moderated in its temperature by re- 
freshing sea breezes ; thus the season was tolerably cool. The beneficial effect of the climate 
was well exemplified in the case of visitors from other places, some of whom, worn out by 
malarious diseases, recovered health after a sojourn of a few weeks at this place. — (XXI. 42.) 
The winter of 1880-81, though prolonged, was mild, but with frequent storms. In the six 
months ending 30th September, 1881, the temperature was considerably higher than it had been 
in the corresponding period of the previous year. — (XXII. 11.) 

During the year ending 31st March,lS72, the general health was most favourable, both as regards 
constant residents and visitors. There being no marshes near this place, ague is not 
met with among the native inhabitants.- — (III. 38.) In that ending March, 1873, the 
health standard was also favourable. — (V. 16.) In consequence of the reputation for healthiness this 
station obtains, a considerable number of persons suffering from various diseases resort to it as a 
sanatorium. — (V. 18.) During the remaining portion of that year the state of public health 
continued good. In reference to the chai^ges for insurance of life at this port, 
Drs. Carmichael and Myers wrote : ' The risk of life here is quite as small as, 
if not less than, that seen anywhere at home ; and it would seem high time that theory, based 



18 EPITOME OF MEDICAL REPORTS. 

on erroneous hypotheses^ should give way to fact discovered by actual experience.' — (VII. 18.) 
During the year ending 30tli September, 1875, the health of the community was unusually good. 
Fever, dysentery, and diarrhoea, so common in the south, are seldom found here. The great 
heat of the summer did not therefore affect injuriously the public health. — (XI. 2.) In the winter 
of 1S75-7G, there was little sickness among the residents. Although, during the summer of the 
latter year, there was great mortality among the Chinese, resulting from scarcity of food, there 
was an absence of cholera and malignant fever. — (XIL 4o.) 

During the half-year ending 31st March, 1878, notwithstanding the severity of cold, the 
health of the foreign community was generally good. Epidemic diseases were altogether absent, 
and no disease occurred that could be attributed to cold. Serious cases of disease, however, were 
not unfrequent.— (XV. 17.) In that ending 30th September, 1878, the health of the community 
was particularly good. No case of remittent or intermittent fever occurred, and, in fact, the 
place is said to enjoy immunity from these forms of fever. — (XVI. 14.) 

The summer of 1879 was healthy, notwithstanding that the rainfall was excessive. — (XVIII. 
71.) During the half-year ending :jlst March, 1880, the health of the foreign community was 
exceptionally good ; there was a complete absence of serious affections. Among the natives the 
health conditions were less satisfactory, several zymotic affections having jDrevailed among them. 
— (XIX. 31.) Throughout the year April, 1880 — March, 1881, the health of the community, 
foreign and native, was remarkably good. — (XXI. 42.) During the half-year ending 30th 
September, 1881, there was a considerable increase in the prevalence of illness, and a very high 
death-rate. The diseases treated during June and July were chiefly intestinal— (XXII. 11.) 

Of the diseases prevalent among the natives about Chefoo the principal are dyspepsia, affec- 
tions of the skin and eyes, and winter cough. Dysentery is occasionally met with in summer. 
Ague is unknown in the immediate neighbourhood, but to the south and west of the 
province, where great plains allow the rains of summer to settle down in the soil, it 
IS not uncommon. Some cases of leprosy have been observed. In the summer of 1871 an epi- 
demic of whooping-cough prevailed, the disease having been imported from Shanghai. — (III, 40.) 
Enthetic diseases are rife. In the course of the winter 1872-73 some cases of diphtheria occurred 
on board ship in the Bay. During the entire year ending 31st March, 1873, a considerable 
number of cases of intermittent fever wei'e treated ; but in all the patients arrived from other ports, 
more especially from Japan, Amoy, Swatow, and Shanghai. Diarrhoea and dysentery were among 
the other prevalent diseases. There was no epidemic of any kind. — (V. 16-18.) Throughout that 
I First Case of J^^'" ^ '^^^^ of Scarlatina — said to be the first recorded in China — came under notice, 

Scarlatina. yariola. Varicella, and rubeola — the latter often of a malignant type, and with 
diphtheritic affections of the larynx — being known to prevail generally. — (VII, 19.) In the 
month of June, 1874, a mild type of intermittent fever prevailed among the residents, chiefly 
affecting children. It took place at the commencement of the rainy season, and was unusual. 
It was limited to families living in cottages without ventilation under the floors, and in badly con- 
structed dwellings where all the sanitary surroundings were notoriously injurious. In the shipping 
in the Bay the average number of cases of disease occurred, including the vai'ious forms of 
venereal dysentery and diarrhoea. Gangrene from cold is frequently met with among the crews 
of Siamese vessels, and more particularly in persons who are weak and anasmic. In these it 
occurs as early as the month of October. Among European seamen this form of disease has not 
been met with. During the autumn and spring months a peculiar kind of laryngeal catarrh is so pre- 
valent among children that scarcely a child under three years of age escapes attack. — (VIII. 50-5(3.) 
In the winter of 1875-7G a case of scarlatina occurred on board II. M.S. Kestrel, its chief interest 



LOCAL CONDITIONS IN RELATION TO PUBLIC HEALTH. 19 

being the fact that that disease is rare in this part of China. In the summer of the latter year 
dysentery of local origin broke out among the adult European residents. It was of malarious 
type, and many of the cases were severe, although recovery took place in all. The outbreak of the 
disease unprecedented here occurred immediately after the first rainfall, and while the tempera- 
ture was at its maximum, Dr. Carmiohael has not seen a single case of enteric fever at Chefoo, 
either in a native or foreigner. He notices, however, that numerous forms of malarious fever 
after certain duration assume the continued form ; and he gives details of a case of ' remittent 
fever with enteric symptoms.' During a practice of fourteen years at Chefoo, he has only met 
with two cases of primary pneumonia in Europeans there. — (XII. 43-47.) Early in the winter of 
1877-78 a case of enteric fever was imported. During that winter several cases of bronchitis 
occurred, the patients being young children. — (XV. 18-20.) In the sis months ending 30th 
September, 1878, two cases of typhus fever occurred. No case of either remittent or intermittent 
fever happened either then or in the six months preceding; in fact, Chefoo again enjoyed immunity 
from these fevers. Among residents there were not many cases of diarrhoea ; the number of cases 
among visitors and shipping was large. In some instances the aifection was attributed to bad water ; 
in others to the use of putrid food purchased at auction and issued to sailors, — (XVI. 15.) In the 
six months ending 81st March, 1879, cases of frost-bite occurred in the persons of some Japanese 
sailors who were wrecked upon the adjoining coast. A few cases of diphtheria, small-pox, and 
scarlatina took place in the settlement itself.- — (XVII. 16.) In the summer half of that year two 
cases of pneumonia occurred. Affections of the digestive system were those which most prevailed ; 
of these, one there was diarrhoea, chiefly among visitors and the shipping. — (XVIII. 71.) Daring 
the half-year ending 31st March, 1881, although measles prevailed in adjacent villages, yet only 
one case occurred in Chefoo. In the vicinity also, the young suffered from whooping-cough, 
illustrating, as stated, the relation existing between these diseases, the one sometimes preceding, 
sometimes following the other. Soon after measles had subsided, the natives suffered from in- 
flammatory sore throat. In some instances the exudation of false membrane simulated diph- 
theria, the skin-temperature marking 103° or 104° Fahr. Some families lost two and three members 
by this disease.— (XIV. 32.) 

CHINKIANG. 



Topography. 



This city is situated on the south bank of the Yangtze Kiang,inlat. 32° 12' 50" N., long. 119° 26' 41 
E. It has an estimated population of 150,000, which by immigration is rapidly on 
the increase. Of native productions the greater number are of infei-ior quality, the 
best part being silk fabrics which are largely exported. Devastated by invaders in the last rebellion, 
Chinkiang has but slowly recovered, and still shows indications of how it suffered. The surround- 
ing low country is principally devoted to the cultivation of wheat and rice in successive crops, 
the hills to the raising of stock. The foreign community in 1876 only numbered about forty 
persons, these residing chiefly in the British Concession, which, small at best, had suffered 
severely in the two preceding years from the encroachment of the river. A new bund had been 
erected, but its eflSciency had yet to be tested. To the south and east of the city are extensive 
hills, 200 to 1,000 feet high. In these, the foreigners had caused paths to be cut, and one may 
wander for many miles amid striking and beautiful scenery. Pheasant, deer^ pigs, and other 
game abound, and to indulgence in the chase is attributed ' the unusually good health of this 
community, which is most singularly free from disorders dependent on excess in food and seden- 
tary habits,'— (XI. 13.) 

3—2 



20 EPITOME OF MEDICAL KEPOB.TS. 

In 1876 the requlremeuts of Lygiene around the city were ignored. 'Even the dead fail to 

receive decent burial, but are frequently left, encased in poorly constructed boxes, 

to the slow process of natural decay, to breed further disease and death.' — (XII. 20.) 

The spring rains of 1877 were unusually heavy and protracted, House and compound walls 

were covered with a low form of vegetation. The system of drainage was of the worst order — 

house drains converted into reservoirs, with no outlet for slops, garbage, and excrement. The 

state of the main sewer is particularly objected to. The relation of drainage to disease was 

exemplified at the Customs establishment during the summer months by a somewhat startling 

list of typhoid affections among the native staff. — (XIV. 62, 03.) 

According to the Eeport to September, 1877, the major part of the water-supply for the 
foreign and native communities was procured at a point but a few yards removed 

"Wftlcr . ... ft • 

from the mouth of the main sewer, and which is a favourite rendezvous for native 
boats. These causes render the water there procured a source of disease hardly to be appreciated 
after long years of immunity, but nevertheless dangerous. — (XIV. 08.) 

In the seven months from September, 1876, to March, 1876, the maximum temperature from 
89° Fahr. in the former month, down to 43° Fahr. in January, then rose to 70' at the end 
of the period. The range of minimum temperature similarly was from 
01° Fahr. in September to 18° Fahr. in January, then upwards to 30' in March. — 
(Xf. 11.) In the succeeding six months of 1870 the actual maximum, 95° Fahr., was reached 
in July. In August and September it was 90° Fahr. in both. The minimum, 44^ Fahr. in April, 
rose to 74° Fahr. in August, then fell to 58° Fahr. in September. — (XII. 20.) During the year 
ending 30th September, 1878, the rapidity and extent of thermometrical changes were unusually 
great. These changes were attended also by heavy snowfalls, rain, and thunder-storms; the 
extremes of temperature greater than in any like period of time in reference to which meteoro- 
logical records are available.- — (XVI. 20.) 

In the year ending March, 1880, the heat of summer was more distressing from its duration 
than from its intensity. The temperature on several days in July and August reached 98° Fahr. 
— (XIX. 6.) The characteristics of the climate during the year ending 31st December, 1880, 
are given as follows : First part of January, fine ; from 10th to 24th, sun and rain at intervals ; 
latter part of the month, fine. First part of February, mostly rainy, with disagreeable weather • 
snow on 4th and 20th; latter part fine, with a few dull and rainy days. March, very fine, with 
only a few rainy days ; on 18th, a thunder-storm and heavy showers. April, beautiful weather, 
with occasional heavy rain ; on 23rd, strong gale from N.W. May, beautiful weather; only a fuw 
foggy and rainy days, and occasional thunder-storms accompanied by light showers; on 30th, a 
gale from the N.W. June, beautiful weather; latter part of the month, thunder-storms and 
heavy showers. July, fine, with occasional thunder-storms and heavy showers. August, beautiful 
weather, with occasional hght showers. September, fine, with a few rainy days. October, very 
fine and clear weather ; on 23rd, strong gale from N.E. November, very fine and clear weather, 
with occasional windy days; 7th and 23rd, gale from N.W. ; 28th, heavy fall of snow. December, 
fine, with occasional cold and windy days; on 14th, 16th, and 19th, snow; on 18th, strono- o-ale 
from N.E.— (XXI. 98.) "^ "" 

In the seven months from September, 1875, to March, 1876, the health of the foreign com- 
munity was reported as good, yet ' scarcely an individual of it but has been affected with some 
form of disease more or less grave; but all cases have readily yielded to treatment, 
doubtless due to the exceptional healthy surroundings.' — (XI. 11.) Small-pox was 
epidemic in the city and suburbs. From April to September, 1876, the health of the community 



LOCAL CONDITIONS IN RELATION TO PUBLIC HEALTH. 21 

was fairly good. This circumstance was in no way clue to any regard paid to the most obvious 
hygienic requirements : namely, the I'emoval of bad drains, stagnant pools, and the system of 
conveying night-soil, and ' various other nuisances.' The diseases most frequently met with 
have included such as were zymotic, cutaneous, and intestinal. Decayed vegetables and fish 
are obtained from Shanghai ; these, together with Ningpo oysters, crabs, and other imported 
eatables, induce diarrhoea and dysentery. No death during the period occurred among foreigners. 
It was not till June that the annual epidemic of small-pox disappeared. A case of ' typhoid ' fever 
in a native is recorded. — (XII. 26, 27.) In the year ending September, 1877, the health of theforoign 
community was not good, and among the natives also sickness prevailed to a greater extent than 
usual. This arose from a combination of causes, including a prolonged rainy season, bad 
drainage, bad water, financial disaster, and improper food. The diseases which most prevailed 
during the six months were typhoid, remittent, and intermittent fever, dysentery, diarrhoea, 
pneumonia, bronchitis, and affections of the liver. Entozoa of various species are very prevalent, 
lumbrici being the most common. Small-pox, as usual, prevailed to a great extent in winter ; not, 
however, amounting to an epidemic. Erysipelas was epidemic during the summer months. — (XIV. 
C2-64.) In the year ending September, 1878, malarious fevers were more prevalent during the 
summer than in previous years, and were more obstinate to treatment. With their exception 
Dr. Piatt 'failed to note, either among foreigners or natives, any unusual form of disease which 
might be attributed to climatic influence.' Nor has the amount of sickness been excessive. 
There has been no epidemic, and small-pox, so constantly met with here during winter and early 
spring of former years, was rarely seen. The health of foreigners was good, and no death occurred 
among them. A peculiar form of ecthyma was observed among salt-workers. — (XVI. 20.) 
During the year ended March, 1880, the health of the community was good, considering the pro- 
tracted heat of summer, which proved most trying to some of the oldest residents of the 
port. No deaths occurred in the foreign community. Intermittent fever was prevalent to 
an unusual degree among the natives at the close of summer and in autumn. Two cases of typical 
typhoid fever were reported as occurring among them ; also several cases of malignant disease. — ■ 
(XIX. 6, 7.) In the year ending March, 1881, the health of the community was unusually bad, and 
especially bad during the last nine months of that year. Considering the cool weather that 
prevailed during summer, the reverse of this might have been expected. There was an unusual 
number of lung cases, as well as some of small-pox and typhus fever. Among other diseases 
recorded were remittent fever, dysentery, and diarrhoea. — (XXI. 98, 99.) 



"WUHU. 

This city, situated on the Yangtze, in lat. 31° 19' 12" N., long. 118° 23' E. (approximate), has 
a population of about 40,000. The houses of foreigners are for the most part situ- 

,,..,.,. Topography. 

ated on the river bank, on alluvial soil ; in summer, when the river is high, it 
percolates through this light sandy deposit; thus, during the later part of spring, in summer, and 
early autumn, the basements are damp, ' and perhaps malarious.' Eew of the houses of foreigners 
possess upper stories. The hills in near proximity to the town present very eligible sites for 
houses of improved construction and arrangement. — (XX. 22.) 

In the six months ending September, 1880, the maximum temperature, 88° Fahr., was attained 
in Mav ; the lowest maximum, 79° Fahr., in April. The lowest minimum, 41° Fahr., 
in April ; the highest minimum, 71° Fahr., in July. — (XX. 23.) 



22 EPITOME OF MEDICAL EEPORTS. 

According to the Report quoted from, the general health of the natives does not indicate an 
unhealthy condition of the situation. At the hosiDital established for them the applicants were few, 
and, except five or six cases of intermittent fever and dysentery, chiefly suffered 
from eye disease, cutaneous affections, or slight injuries. The health of the foreign 
community was hardly satisfactory. From time to time some suffered from general 'malaise, 
gastric disturbance, accompanied iu some cases by diarrhoea, in others by constipation ; the 
axillary temperature r5° to 3° Fahr. above the normal, the rise most marked in the afternoon. 
These symptoms of slight and latent forms of malarial fever continue from two to six days, then 
pass off under the use of quinine. The cause of these attacks is not to be found in the habits or 
mode of living, and although the climate is in most cases blamed, it is far from being unhealthy. 

KIUKIANG. 

In reference to this settlement the following are the particulars that have been obtained from the 
Reports now available : 

In the Lii-shan hills, a range about 5,000 feet high, miles south of Kiukiang, is a pleasant 

summer retreat in one of the gorges that intersect these picturescjue mountains, 

which mny be regarded as the sanatorium of both Hankow and Kiukiang. The 

little bungalow there was in 1870-77 owned by a company, but great consideration was given by 

its members to the requirements of invalids, to whom, especially during hot summers, such a 

retreat is of priceless value. — (XIII. 1.) 

The subsoil of native houses in Kiukiang is generally sloppy or damp, always undrained, 

and seldom boarded over with any proper flooring, so that there is a constant ascent 

of damp vapours and unwholesome exhalations.- — (II. 02.) 

The dietary of the poorer classes of Chinese residents consists mostly of rice and vegetables, 

with a little fish or bean-curd — seldom flesh meat. — (II. 62.) It is little fitted to 

maintain bodily vigour, especially when persons have to work hard and labour 

Habits. indoors, as tailors, watchmakers, brasiers, etc. As the Chinese are proverbially a 

quietly moving race, fractures are rare among them. — (XIII. 4.) 

The following thermometrical observations were takea within doors, in a fireless room with a 
northern aspect, at 8 a.m. : — 1871, January, 05°. February 35° ; considerable falls 
of snow, and hard frost towards the middle of the month. March, 45° ; rain for 
ten days, with one storm of thunder and lightning; river risen 10 feet by the 20th of the month. 
April, 59°; rain, 11 days; one tempest; 3 thunder-storms; thermometer stood at 74° several 
days. May, 70°. June, 811°; heavy rain, 4 days; 9 days of storm or breeze from N.E. ■ 
9 days oppressively close and hot. July, 87° ; 2 hurricanes ; 4 breezy days ; 4 days of thunder 
and lightning; 94° and 97" recorded on several days. August, 80°; 3 days of high wind; 5 of 
heavy rain. September, 80° ; 2 days of rain ; 8 of fine N.E. breezes. October, 68°; 3 days 
rain ; 9 of fine E. breezes. November, 55° ; 2 days rain ; 2 of fine N.E. breezes ; on 14th a 
storm from the N.W., accompanied by a heavy fall of snow ; it was felt in Shanghai precisely 24 
hours after. December, 44°; fall of snow on the 1st; high N,^Y. winds, 2 days; sharp frost ; 
thermometer at 38° on 3 days. — (IV. 43.) 

In 1872, January, 39J° ; falls of snow towards middle and end of month ; high winds on 20th 
and 21st; ice in bedrooms on 22nd to 2 1th. February, 40° ; thaws and heavy rains; little frost or 
snow throughout the month. March, 55i° ; fall of snow on 3rd and 4t]i ; the hills again dusted 
with snow on the 29th; heavy rains and sultry weather; temperature averaging 60° from the 



LOCAL CONDITIONS IN RELATION TO PUBLIC HEALTH. 23 

lOth ; the magnolia, peach, chei'ry, mezereou, fairy columbine, and star of Bethlehem blossoming as 
early as the 15th of the month; on the 21st, heavy storm of thunder and lightning out of a clear 
sky; on the 25th and 26th, a furious tempest from the south, with scorching heat ; afterwards wind 
from the N.B. April, 65f° ; it rained on 17 days ; thunder and lightning on 4 days; high winds, 
variable, 4 days. May, 73^; rain, 10 days; thunder andhghtning, 2 days. June, 78° ; highest 
registered thermometer within doors, 86°; rain for 15 days successively from the middle of the 
month ; water over the bund on the 22nd. July, 88° ; first, several terrific storms of thunder and 
lightning, and then raging hurricanes, the night temperature varying but slightly from that of 
the day. August, 88° ; the temperature was frequently 94° and 96° in the shade in the after- 
noon ; 3 days of rain ; 3 of high wind ; on the 20th the chastened mellow light of autumnal 
mornings first remarked. September, 79° ; fresh N.E. breezes during 10 days. October, 69° ; 
N.B. breezes till 15th, then N.W. till 27th, then again N.E. ; sudden alternations of temperature 
within a range of 10° or 12°. November, 56° ; high N.E. breezes for 10 days ; hoar-frost on the 
mountains, 2 days ; no rain ; mornings and evenings chilly, even severely cold ; mid-day heat 
equal to that of an English summer. December, 44° ; mild weather, with the mercury above 50° 
during the first half of the month. 

In 1871 no fewer than 2,456 cases of disease and injury among the native Chinese were 
treated at the Kiukiang Dispensary. Dr. Shearer gives the following particulars in 
regard to the diseases so observed : ' The prevailing afEection of the skin was ^''^'^''^■ 
scabies. In reference to disease of the teeth, decay is less common among the Chinese than 
among Europeans, probably on account of the simple nature of their dietary. Dysenteric 
diarrhoea and dysentery are usually mild ; thei'e is also less prostration in cases of these diseases 
m natives than in Europeans. Some of them occurred in opium-smokers who had recently given 
up the practice. As indicating the connection between dysentery and ague, and the dependence of 
both on malaria, the occurrence of both diseases in diiferent members of the same family, but 
under the same conditions, is noticed. Thirty-three cases of pulmonary consumption were treated. 
Many were due to poor living and damp houses. One man, aged 48, had been consumptive for 
thirty years, expectorating blood in large quantities every two or three years, yet performing his 
work. His son died at the age of 20, of consumption. The diseases of the nervous system in- 
cluded apoplexy, delirium tremens, paralysis, convulsions, and acute mania. The forms of disease 
affecting the eyes wei-e numerous. Intermittent fever and its sequelas were of frequent occurrence ; 
some were recorded in which that form passed into severe remittent, with continuous febrile action 
and slight remissions, but without distinguishable chills. The practice of opium-smoking was 
considered protective against intermittent fever ; several examples of the disease occurred in 
persons who had recently broken off the habit, and two (only) in opium- smokers. Among the 
sequoias of intermittent fever are enumerated, anaemia, anasarca, chlorosis — the correct treatment 
for which, according to the Chinese themselves, is " the wearing of a solid ring of silver round 
the neck." Other sequela3 include ague-cake, with or without ascites. Venereal diseases in 
severe form, primaiy and consecutive, prevail extensively among the people. On this occasion, 
bnly two cases of small-pox were recorded.' — (II. 61-66.) The summer of 1872 was long and 
trying, though not unhealthy as regards foreign residents. The autumn was remarkable for an 
epidemic of malarious fever of most malignant character among the natives in the Epidemic Malarial 
districts of Lin-kiang and Suy-chow, south of the Poyang lake. Also, during ^"'''"■• 
autumn, diarrhoea, dysentery, cholera, fever, and intermittent fever occurred, but nothing more 
than common. — (IV. 44.) 

During the ten months ending 31st March, 1875, in the foreign community, numbering nearly 



24 EPITOME OP MEDICAL REPORTS. 

sixty individuals, there was little sickness, and tlie cases as a rule were of no great gravity. 
Dysentery yielded to the ipecacuanha treatment. In the autumn of 1874 an epidemic of boils pre- 
vailed. — (IX. 1.) During the year ending 31st March, 187C,the health of the community was good; 
no epidemic prevailed, and disease was generally mild in type. Here, as elsewhere in China, diarrhoea 
in children during dentition is of frequent occurrence. — (XI. 14.) In the year from 1st April, 
1S76, to 31st March, 1877, although the summer season was unusually mild, diarrhoea, dysentery, 
and malarial fevers were of frequent occurrence. This increase in their prevalence was considered 
to be due to ' peculiarity ' of the season, ' and to a flood, which, for ten weeks, partially deluged 
the Concession and the low-lying districts in the neighbourhood.' The actual temperature during 
the greater part of the time from June to September was, on an average, little over So'' Fahr. 
With a view to counteract the miasma arising from the submerged ground, quicklime was spread 
over it ; but according to the Report, ' it was at this particular time that sickness was more 
prevalent than at any other period during the year.'' Quinine was given as a prophylactic. 
In the latter half of the year, the community was remarkably free from sickness, and no death 
among foreigners occurred during the entire year. — (XIII. 1.) Throughout the year ending 
31st March, 1878, the health of the foreign community was exceptionally good. — (XVII. 1.) In 
the summer of 1878, a flood, lasting from 21st July to I7th September, overflowed the low-lying 
country adjacent to Kiukiang for many miles in nearly every direction. This flood deprived 
most of the people of nearly all their woi-ldly substance, reducing them to a state of destitu- 
tion. Typhus fever occurred, of which a few died. Further mortality was probably averted by 
relief furnished by the native authorities, who dealt out daily issues of rice and other neces- 
saries. Among foreign residents an unusual amount of sickness prevailed, for which Dr. 
Jardine was unable to account satisfactorily. Possibly it was accounted for by the unusual 
duration of close sultry weather, combined with the depressing influence of the flood. One case 
of typhoid fever occurred after a lapse of five years. — (XVII. 2, 3.) 

In the year ending 31st March, 1880, the health of the community was very good. — (XIX. 9.) 
In that ending 31st March, 1881, the health of the community was fairly good. In the 
early part of the previous summer the weather was exceedingly temperate, and little sickness 
occurred. In autumn, remittent and intermittent fever, both unusually severe and obstinate, 
affected a large proportion of the community; those who sufl:ered most severely from these 
diseases were such as were in the habit of bathing in the evenings in the lakes after the water 
had begun to subside over the flooded districts. In winter, catarrhs were frequent. In the 
neighbouring districts sickness was unusually prevalent. It has been often remarked that 
unusually mild summers have been accompanied or followed by an increase in sickness. At a 
hospital opened by the Catholic Mission of Kiukiang malarial fever far exceeded any other 
diseases. jMany cases of their sequelfe were also treated. Cutaneous diseases ranked next, due in 
no small measure to the filthy habits and indigent circumstances of the people. Bye diseases 
ranked first in regard to numbers. Dysentery was very prevalent during the autumn. Only 
three cases of leprosy were met with.— (XXI. 48, 49.) In the year ending 31st March, 1882, the 
health was good ; there was no epidemic. In April and May bronchial catarrh and diarrhoea 
prevailed ; in Juno intermittent fever, which readily yielded to treatment. In July and August 
cases of sunstroke and cerebral congestion occurred ; in September cases of dysentery and severe 
remittent. In December a case of typhoid fever was treated. In the country around Kiukiang 
much sickness prevailed among the Chinese during the summer and autumn. In June a fatal 
epidemic of what was considered to be remittent fever prevailed at a village 30 li east of Kiukiano-. 
Only two cases of elephantiasis were treated during the year. — (XXIII. 38.) 



LOCAL CONDITIONS IN RELATION TO PFBLIC HEALTH. 25 

HANKOW. 

The geographical position of Hankow is lat. 31° K, long. 112° 10' E. The city (1871) stands on 
a strip of mixed and silicious sand lying at the junction of the river Han with the 
Yang-tze-kiang. At different seasons the level of the town in relation to the river °P°s^'^P i'- 
ranges from 2 to 4 feet during autumn up to 40 to 60 feet in winter. Since the opening of this 
port in 1861 the town has been three times submerged, namely in 1866, 1869, and 1870. 
After each of these occasions, vacant spaces being covered with vegetable decomposing debris, 
fever and cachexia occurred. Some low-lying parts of the town remain swampy after ovei'flosvs; 
it is accordingly proposed to drain them. The English settlement adjoins, but is apart from, the 
portion of the native city which stretches along the Yang-tze. The benefit of this separation is par- 
ticularly seen in the limitation of small-pox, which has been repeatedly and severely epidemic 
among the Chinese in the city without having attacked a single foreigner residing in the Concession. 
On the other hand, while foreigners lived in the city not a year passed without a sprinkling of that 
disease amongst them. — (II. 44, 45.) The condition of the site is thus adverted to in the Report 
on the settlement for the half-year ending March, 1881. According to Dr. Begg, it 'is a flat, 
just below the Chinese town and the entrance of the Han river into the Yang-tze. A part of the 
ground had formerly been used as a burying-ground. Along the bund the river- water is saturated 
with animal impurities ; yet this water is used by the community, the only means of purifying it 
being alum. — (XXI. 44.) 

Heaps of filth are accumulated in the native streets and houses ; in the absence of drains and 
scavengers, these remain until washed away by inundations of the river, which from 
time to time occur. Adverting to the method in use here, as elsewhere in China, of 
retaining soil-matters in pits until they have reached an advanced stage of decomposition. Dr. 
Reid writes : ' It is possible that even if the excrement originally contained the germs of zymotic 
diseases, they would pass through their stage of existence before the pollution is thrown into the 
air. It is only by some change which has taken place during this preparation of the sewage that 
we can explain the usual freedom from enteric affections of the labourers who apply it to the 
fields, and dwell in the midst of the efiluvia."^ — (II. 44.) According to the Report for the half- 
year to March, 1872, drains 3 or 4 feet deep and 2 in width run along the centre or sides 
of streets. They have no sufficient fall, and thus speedily become blocked up with mud and 
refuse. Between the latrines of private houses and the main drains there are usually small closed 
channels, so that regurgitation both ways of gases must of necessity take place. The latrines are 
numerous. They are constructed without regard to cleanliness. Their contents are allowed to 
accumulate for three or four weeks, and then they are carried to the jetties in uncovered buckets, 
occasionally during the day, but more generally at night. While this process is going on, the 
neighbourhood is saturated with odours of the most intense description. Notwithstanding the 
apparent undesirableness of the locality, in some cases private dwellings, and even restaurants 
doing a thriving business, may be seen attached to the latrines, and only separated by a wooden 
partition insuiEcient to oppose the entrance of polluted air. During the rise and fall of the river 
the subsoil becomes saturated, then gradually dried. Yet there is an absence of enteric fever. 
(III. 43, 44.) According to the Report for the year ended 30th September, 1877, ' with the dis- 
appearance of marshy ground near the settlement there is a good prospect of the diminution or 
disappearance of malarial fever during years free from a general inundation.' — (XIV. 79.) In 
1881 steps continued to be taken to raise the whole Concession above the usual flood-level. 
Adverting to this subject. Dr. Begg wrote : ' To raise it — with the exception of the ground 

4 



2G EPITOME OF MEDICAL REPORTS. 

niiderneafJi tlie houses — converting it thus into a fevei'-trap. Not content with a perfect surface 
drainage, they introduced that which is dangerous at its best and deadly at its worst, namely a 
system of drainage — a system of drainage without a fall, or three feet of fall divided over the 
system ; drains whose outlet for many months of the year is below the level of the surroundmg 
water ; drains made of porous bricks, without ventilation, except for the communications with 
houses and streets.' — (XXI. 41.) 

At a short distance behind, a wall stretches between the two rivers, and in that direction 
encloses both the city and a considerable piece of land, divided into vegetable 
giicu uie. gg^p^jQj^g^ These plots are watered at all hours of the day with a rich liquid manure, 
consisting of the night-soil of the city population; and according to Dr. Eeid's Report, 'this 
effectual, profitable, but most disagreeable method of utilizing the night-soil seems here devoid 
of special evil consequences to health, notwithstanding that those engaged in the culture of the 
vegetables constantly respire a highly impure atmosphere.' — (II. 44) 

The water-supply is drawn (1871) from the muddy river. Before being used for drinking 

purposes it is precipitated with alum, then heated and filtered. These precautions 

are needful, because of contamination by the refuse of the city above, and of the 

enormous boat population living on the Han. ' Notwithstanding these precautions, dysentery 

in autumn affects both natives and foreigners.' — (II. 45.) 

In 1871, the European population of Hankow, although somewhat fluctuating, usually 
averaged 110 adults, and from 10 to 20 children. All were in easy circumstances, and engaged 
in indoor occupations. According to Dr. Reid, although the temperature of the 
air is but little below that of the body during the summer season, and exercise can 
only be taken on a limited scale, a considerable amount of heat-producing and reparative 
material may daily be consumed with wonderful impunity. — (II. 45, 46.) Adverting to the preva- 
lence of leprosy among the poorer classes of Chinese from the neighbouring districts, and to the 
circumstance that the disease is attributed to their state of poverty and hardship, he writes : 
■■ In their better days the ordinary diet of the labouring classes consists of a pound and a half of 
green or preserved vegetables prepared with a little oil, and a somewhat less 
cjuantity of inferior rice daily. Pish is only occasionally partaken of, and then iu 
very small quantity. Pork and beef are tasted only once or twice a year. The winter clothing 
and houses are on a par with the diet ; the former made of cotton cloth, affording a thin and 
insufficient protection; the latter, a congeries of filthy mud cabins with accumulations of excre- 
ment in close proximity.'' — (II. 55.) 

Throughout the year ended 30th September, 1871, the thermometer ranged from a few 
degrees below freezing-point to 90° Pahr. in the shade in summer. The hot season 
begins in May, and ends early in September; the day temperature seldom under 
88° Pahr. or over 94° Fahr. Often days and nights occur in which the atmosphere is still, the 
nights more oppressive than the day. September is the most trying month of the year, its 
temperature variable, chilly breezes at night. During it malarial fevers prevail among the natives, 
and occasionally also affect foreigners. — (II. 45.) In the summer of 1874, the temperature of 
May ranged from 91° to 94° as a maximum; so also in June, July, and August. In September 
the maximum was 100° up to 11th ; on that day it fell to 66°, and the severity of summer ceased. 
— (YIII. 48.) The frequent variations in the temperature of the air constitute a characteristic of 
the climate. The year ended 30th September, 1876, was characterized by comparative coolness 
and dryness of the summer, and the unusual prevalence of breezes at night. — (XII. 14.) 

In 1871 it was recorded that malarial fevers, which prevail in September and October, affect 



LOCAL CONDITIONS IN RELATION TO PUBLIC HEALTH. 27 

alike natives aud foreigners. Those that occur after overflows of the Yang-tze-kiang also 
follow this rule. Dj^sentery usually infests the nabive city in autumu. Since 1865 
„ arge proportion of the mortality among foreigners at this place has been 
caused by that disease ; three-fourths of the mortality by it occurred among the minority who 
had to reside in the native city, and children were the most severely affected. In sporadic form 
it occurs annually at Hankow in May, rarely becoming epidemic before autumn. In 1871, how- 
ever, mstead of that disease, chest affections and fevers prevailed. Here, little tendency exists 
towards serious hepatic or splenic complications of dysentery as in India ; an ' enormous per- 
centage of mortality' among children was noted, chiefly occurring during dentition. — (II. 45, i&.) 
Beyond those from climatic causes, whooping-cough in spring and an unusual freqaency of con- 
tinued and remittent fever in autumn were the only epidemics recorded. In the treatment of the 
fever belladonna was given, with the result that a scarlatinoid eruption, succeeded by general 
anasarca, quickly followed ; these ceased on the drug being discontinued. The cases of fever 
were for the most part among foreigners, of no great severity. A case adynamic in type 
occurred, and proved fatal in a young woman ; she was occupied in a nursery on a ground-floor, 
and close to a foul drain ; in May she had an attack of fever ; during June and July it reappeared 
as an intermittent. In August quinine was prescribed, but without benefit. 

In the six months ending March, 1872, no epidemic febrile disease occurred. In February, 
with a rise of from 20° to 30° in the maximum temperature, a prevalence occurred of malarious 
diseases chiefly of the intermittent and remittent type. The absence of any type of exanthematous 
fever was hardly to be anticipated, knowing the filthy condition of the houses and streets, density 
of population and poverty. Small-pox was extremely rare. — (III. 43.) In the six months ending 
September, 1872, a large proportion of the fever cases were brought from the country districts, 
the majority malarial. — (IV. 72.) In the half-year ending March, 1873, parotitis was the only 
epidemic disease observed ; its type was mild. — (V. 31.) Insolation is of rare occurrence among 
foreigners at this port. In the summer of 1873 two cases occurred, both on board H.M.S. 
Bingdove. Neither of the men had been exposed to the sun. In one the attack began towards 
midnight, in the other shortly after daybreak. Temperature of the air at the time max. 85°, 
min. 84°, wet bulb 81°; vacuum solar thermometer, 161° at noon, 158° at 4 p.m. — (VI. 33.) 
During the summer of 1874, fever, ague, and dysentery occurred among the natives. In some 
cases fever and dysentery were combined in the same subject ; in one case the fever was com- 
plicated with pneumonia. Other diseases more or less prevalent were rheumatism, dyspepsia, 
' malaroid'' disorders, bronchitis, phthisis, conjunctivitis, ulcers, and scabies. — (VIII. 43.) In the 
six months from April to September, 1 875, the general health of the community was characterized 
by the prevalence of ' malaroid ' disorders, assigned to heavy rainfall in June, and overflow of 
the river in July. Suppurative hepatitis and dysentery were endemic, and were the chief causes 
of serious illness among the foreign residents. On 6th of August, three cases of sunstroke 
occurred. At 4 p.m. on that day, the maximum thermometer was 96', wet bulb 85°; black bulb 
in the sun 152', min. on the grass 95° Fahr. — (X. 46, 47.) The summer season of 1876 was 
comparatively cool, the atmosphere dry ; yet it was by no means a healthier season than usual. 
Malarial diseases prevailed, due, it was believed, to filthy ponds and inundated tracts near the 
settlement. Dr. Reid writes : ' Although a marshy district and wet decaying organic matter are 
not the only necessary factors in the production of malaria, which is occasionally met with in a 
dry soil, and even in mountainous regions at a height of several thousand feet, yet there is often 
a causative relationship between them.-" A few cases of rotheln were met with in spring, but the 
disease did not assume an epidemic form ; small-pox prevailed as such. — (XII. 14, 15.) During 

4—2 



28 EPITOME OF MEDICAL KEPORTS. 

tlie year ending SOth September, 1877, no examples of severe malarial fever were met with 
among foreign residents, a decrease in these diseases considered to be due to local improvements. 
Small-pox wasmoderately prevalent in tire neighbouring cities dm-ing the winter and spring months. 
—(XIV. 79.) In the year ended September, 1878, a number of cases of cholera occurred, 
in the first instance among the workmen engaged in the brick manufactories ; the disease then 
spread among the natives residing in the convent. The health of the crews of the shipping 
was satisfactory. A few cases of dysentery and of malarious fevers among the foreign residents. 
— (XYI. 23.) According to the Eeport for the half-year to March, 1881, the health of the foreign 
community, ' in spite of the unhealthy situation of the Concession, will compare favourably with 
that of any port in China.' Dr. Begg remarks on the difHculty there is in treating medical cases in 
Chinamen, even in hospital. 'Their houses, mode of life, diet, dirt, ignorance, and prejudice, 
are all arrayed against us.' Of those who applied as out-patients not more than 50 per cent, 
returned a second time. The relation between their sexes gave 20 per cent, of females, 80 
of males. The diseases which most prevailed included remittent and intermittent fever, 
dysentery, dysenteric diarrhoea, and simple diarrhoea. Among the Chinese, several cases 
occurred of a fever which ' ran the typical course of typhoid.' Parasitic skin diseases, syphilis, 
and ophthalmia in aggravated forms among them were due in great measure to dirt. — 
{XXI. 44-4(5.) 

ICHANG. 

IcHANa is situated in lat. 30° 14' 25" N., long. 111° 18' 34" B. It lies on the north bank of the 
Yang-tze, about 1,000 miles from the sea. The foreign population number 17 persons, including 
ladies and children. They all live in native houses. The Concession is bounded by the 
river in front; at the back is a piece of ground in which formerly the Chinese buried 
their dead. The city side rises considerably from the river. Any decomposed vegetable matter 
from rice-fields which lie at a considerable distance to the back of the concession is thrown in a 
northerly direction. The settlement, however, is liable to inundations. Such catastrophes are 
expected every ten years; but at the date of the Report to September, 1880, ten whole years had 
elapsed without a flood of this kind. On the hills and in the valleys on the opposite side of the 
river pleasant walks may be had, although the roads are bad. — (XX. 18, 19.) 

According to the Report to September, 1880, the sanitary conditions were most deplorably 

neglected, and yet the foreign residents enjoyed comparatively good health in it. Efficient drainage 

is utterly uncared for by the Chinese, aod no precautions whatever are taken to 

prevent obnoxious smells or clear away rubbish from the mouths of drains. 

Privies are numerous; they are emptied once a week, when their contents have had ample time to 

undergo putrefaction. The farmers carry away the soil. — (XX. 18.) 

The summer of 1880 was less hot than that of 1879. The two hottest days in that of 1880 

were 4th July and 2nd of August, on both of which the temperature was 91° Pahr. Considei'able 

rainfall served to keep the atmosphere cool without inconvenience otherwise. The 

heat had no bad effect on the residents. In the surrounding country the air is 

bracing, and only tbreo miles up the river is the commencement of the gorges of the Yang-tze, 

where a complete change is experienced by the visitor. — (XX. 19.) 

The health of the foreign residents during two years prior and up to September, 1880, was 

upon the whole very good. This is more especially noted, as all foreigners live ia 

native houses, and the majority of them inside the city wall in localities where it is 

hardly possible for them to escape the effluvia caused by the inefficiency of sanitary arrangomeuts. 



LOCAL CONDITIONS IN RELATION TO PUBLIC HEALTH. 29 

Icliang has the name of being unhealthy, but Dr. McParlane is decidedly of opinion that, on the 
contrary, the place is healthy. — (XX. 18, 19.) 

According to Dr. McFarlane, the native Chinese will undergo any amount of pain, and drink 
medicine ad libituvi, if permitted to go home from the Dispensary, He hopes to be able in a year 
or two to overcome their prejudices against the foreigners. Skin and eye diseases 
are the most prevalent. Ague cases are numerous, but no other form of fever 
appears to affect the natives of Ichang. There is a reported absence of epidemic disease and of 
elephantiasis, and a scarcity of morbid growths among the natives. The last epidemic of cholera 
in these parts was in 1850. — (XX. 20.) 

SHANGHAI. 

The geographical position of Shanghai is lat. 31° 14' 32" N., long. 121° 29' 8" B. The settlement 
occupies a point of land at the junction of the Woosung and Wongpoo, both rapid 
rivers. The surrounding country for many miles in every direction is purely alluvial, 
intersected by numerous creeks, and studded with towns and villages chiefly in- ''^' 

habited by agricultural population. The soil is extremely prolific, and except when actually 
frozen, is under constant cultivation. Eice is grown in considerable quantity. From the 
middle of April onwards the numerous natural swamps are supplemented by deeply irrigated 
fields. A very large extent of land close to the foreign settlement is thus periodically submerged, 
a condition highly unfavourable to health, and intensifying the action of these causes which, on 
the deltas of all great rivers, tend to produce disease. The Shanghai district is therefore to be 
qualified as ' malarious,' the convenient term ' malaria ' being used to designate the 
mass of describable and indescribable conditions which prevail in the neighbour- 
hood of marshy lands, especially when these are subjected to powerful heat. Daring the spring, 
summer, and autumn months the fields are plentifully manured with night-soil, more or less 
diluted, which has been preserved in vats until it has attained a stage of matura- 
tion judged of by some standard known to the Chinese themselves. ' At first this 
would appear to introduce a very hurtful ingredient into our breathing air, and there is 
suflScient evidence that the atmosphere is filled with pungent particles from the ground so treated. 
But whether it be that the process of maturation is fatal to the life of those germs upon which 
epidemic disease is said to depend, or that their large dilution with pure air renders them incon- 
siderable (a supposition which the reporter considers quite untenable), or that the original 
material neither contains nor develops disease germs at all, the fact is that disease can never be 
traced to this cause alone.'' Dr. Jamieson continues : ' It is well to add that no authentic case of 
disease arising from the adoption of sewage irrigation has been observed in the neighbourhood 
of the farms so treated. The fluid sinks rapidly beneath the surface, and is filtered through the 
soil, the roots of the growing plants appropriating the organic materials while the water drains 
away.' This description is to a considerable extent applicable to the plan of manuring in vogue 
in China generally. — (II. 33.) 

The flatness of the site of the settlement renders efficient drainage all but impossible. No 
night-soil reaches the drains, as it is retained in vessels, and careful scavenging reduces to a 
minimum matters to be removed by drains. Filth and vegetable refuse left in 
unfrequented spots are carried by rains into the drains, and the constant traflic 
along the narrow streets renders the quantity of refuse matter very considerable. The quantity 
of refuse and offensive matter from boats and shipping which finds its way along canals and water- 



30 EPITOME OF MEDICAL REPORTS. 

courses is great. Certain reclamations of land on tloe banks of the river were in progress. The cer- 
tificate of the health officer was declared sufficient to authorize the forcible removal of noxious 
accumulations^ and the purification of unwholesome dwellings, drains, cesspools, etc. — (II. oi, oo.) 
The Report for the half-year ending 31st March, 1872, contains an enumeration of improvements 
in progress iu regard to sites and construction of houses, drainage and state of roads. — (III. io.) 
Progressive improvement in the sanitary condition of the settlements and suburbs was reported 
to March, 1873.— (Y. 50.) In the Report to September, 1875, the remark occurs that five years 
ago Dr. Barton observed that foreigners in China owe much of their immunity from disease to 
the primitive system of water-closet accommodation which is in vogue; that they thus escape all 
the dangerous and often deadly gases which rise from imperfectly flushed drains, and the risks 
of domestic water pollution incidental to European houses to which water is laid on, and in which 
there are more or less ' scientifically ' devised closets. — (X. 57.) According to the Report to 
March, 1879 : ' In all matters affecting the health of the settlements, with the exception of a 
provision for good water, the Municipal Councils are working vigorously j roads widened; 
drainage extended; streets and alleys cleansed; creeks as far as possible kept clean ; roads kept 
in good order; public gardens improved; trees planted on the bunds and along roadsides; 
hospitals subsidized, etc' — (XYII. 18.) 

In the Report on the settlement to oOth September, 1871, the following remarks occur : 
AVhatever does escape — that is, of the contents of pent-up sewers — is carried 
Into the river. Into the river, through the drains, comes the drainage from up- 
country villages and fields. The shipping in the stream contributes its refuse ; the ditches of 
the native city are washed out at each time of spring-tides, filth of all kinds swelling the list 
of river impurities. The Municipal Council having submitted various examples to Professor 
Prankland, it was proved by analysis that instead of being exceptionally bad, the water- 
supply, in spite of all that must mingle with it, is exceptionally good. Dr. Jamieson observes 
that, whether generally contaminated or not, the river is liable to contamination on an alarming 
scale, should any disease such as typhoid, dysentery, or cholera break out on board the ships, or 
an accident happen to the heavy-laden manure boats. According to the Report for the 
half-year to 31st March, 1872, the prevalence of dysentery and of ''enteric' fever is con- 
sidered to be connected with the water-supply, that for drinking and washing purposes being 
obtained from the river. Even a case of suppurative hepatitis was assigned to the water- 
supply of this settlement.- — (II. 34, 81.) According to the Report to March, 1873, ' water-coolies 
fill their buckets impartially at all states of the tide, and as frecpently as not take their supply 
out of the drain-mouths. Nearly the entire water-supply is derived from the river, the 
Soochow creek, and the Yang-king-pang. Little, if any, night-soil finds its way into the 
sewers, but much putrefying matter is necessarily washed into them by every heavy shower of rain. 
From foreign ships and native boats, however, a considerable amount of fa3cal contamination of 
the river- water takes place; and this water is drunk after simple filtration, and the addition of 
alum to it. In reference to this subject, ' two points are important — that dilution is no measure 
of safety, and I hat it is of the essence of organic germs, even when most sparsely diffused, to multiply 
indefinitely.' — (Y. 60.) In the Report to 30th September, 1873, it is observed that nothing short 
of precipitation and filtration, followed by boiling and a second filtration, can render the creek- 
water fit for domestic use. Without the most sedulous care on the part of foreign residents 
on the Bubbling Well Road, the water used in their houses for drinking and cooking pur- 
poses must be extremely imjjurc. — (YI. 55.) In the Report to olst March, 1874, it is stated 
that typhoid fever and dysentery continued to be endemic at that place, and that ' there appears 



LOCAL CONDITIONS IN RELATION TO PUBLIC HEALTH. 31. 

to be good reason for assuming that tbe water used in tlie settlement is a main cause of both.' Dr. 
Jamieson wrote : ' It is a just subject for astonishment that while the members of the Shanghai 
community doubtless accept the received doctrine of the non-specificity of dysentery, and the 
well-supported doctrine of the non-specificity of typhoid, they make no eSort to provide what 
in all civilized countries is regarded as the most fundamental hygienic arrangement.' He then 
advocates the formation of a waterworks company, and in the meantime recommends the use 
of filters.— (VII. 34.) 

In the Report on that settlement to September, 1874, the medical officer recurs to the sub- 
ject of water. He alluded to the question 'at issue' as to whether water not specifically 
contaminated can produce ' enteric ' fever. He replied that ' we never know enough of the 
diseases prevailing among the Chinese around us to enable us to assert that the water drawn 
from the creeks is not, probahlij, so contaminated.-" He adds, ' Experience in India is decisive as 
regards the sjjontaneous origin of typhoid, but it appears i:irobahJe that the disease arises there 
among young soldiers from causes more pui'ely climatic than those which produce it at 
Shanghai.'— (VIII. 17.) 

In the Report for October, 1874, to March, 1875, the medical ofiicer wrote: 'The most 
elaborate system of filtration will remove only the inorganic suspended matters and grosser 
organic impurities held in suspension. As regards all substances dissolved, and all minute 
organisms, water leaves the best filtering beds in the same condition in which it entered them. 
Ordinary Shanghai drinking-water is reported to be, after filtration, unobjectionable from a 
chemical point of view, but swarming with bacteria and vibrios, and therefore to be regarded as 
suspicious, if not dangerous. The unobjectionable character of the water after filtration, so 
far as regards dissolved impurities, is further attested by a most competent analytical chemist. •" 
Dr. Jamieson, having examined the water of Shanghai, writes : ' Prom the very small amount of 
nitrogenous matter present, he concludes that the water in the Woosung below the settlements at 
high water consists almost entirely of water from the Yang-tze, and, from the small proportion of 
lime and magnesium salts present, that sea-water must be completely absent.' He considers the 
water taken at high water from the Woosung, and at some distance below the settlements, to be 
well suited, after thorough filtration, for general use for drinking, washing, or other purposes ; 
while Parkes says that '' it is uncertain how far boiling will destroy the poisons of specific 
diseases,' and quotes Lex to the effect that some bacteria move rapidly at a temperature of 
260° Fahr. On the other hand, Bastian says : ' It has been established that living protoplasm 
is entirely destroyed by sudden exposure to a temperature of 140° Fahr. when in the moist state, 
irrespective of the fiuid in which it may be immersed.' Dr. Jamieson states, with regard to the 
Shanghai water, that 'the simple precaution, therefore, of boiling all the filtered water, either by 
itself or mixed with wine or spirits, renders the consumer absolutely safe. The two processes 
should invariably be combined : first filtration, and then boiling.' He says : ' The advantage of 
boiling water before drinking it was well understood in ancient times. Herodotus, writing about 
450 years before the Christian era, of a period a century earlier, says (i. 188) : "The great king;, 
when he is on a campaign, is supplied from home with provisions well prepared, and with cattle. 
Moreover, he carries with him water from the river Choaspes, which flows past Susa, whereof 
alone, and of none other, does he drink. And with this Choaspes water, prevmisly boiled and 
stored in silver vessels, many four-wheeled mule-carts are laden, which follow him whithersoever 
he marches." Even boiled water, however, should be drunk not later than 24 hours after boiling. 
It cannot be too distinctly understood that dangerous qualities of water are not obviated by the 
addition of wine or spirits.' — (IX. 7, 9.) In 1878, Dr. Jamieson wrote that 'the water supplied by 



"2 EPITOME OF MEDICAL EEPORTS. 

the two private companies establislied here is reported by competent analysts to be unobjection- 
able in every way.' — (XV. G.) 

The habits of the lowest class of residents resemble those of the corresponding class in all 
seaport towns. At this place the evils of those habits are increased by the violence of solar and 
malarial influences. These are uncontrollable^, but habits of individuals are in their 
own keeping. The better classes of residents are careful as regards diet and 
shelter. They sleep on the second floors and among them imprudence in eating and drinking is 
the exception. Heavy drinking is not common, although certain American drinks were better 
abolished.— (II. 41.) 

In summer, when exercise cannot be taken, there continues to be constant exhaustion of vital 
energy, due to extreme heat, and this demands sustaining food. During hot weather, so-called 
' respiratory ■" articles of food are avoided ; but the need for blood-renewing food is undiminished, 
and in some instances increases. The loss of fluid by perspiration, though j^artly balanced by 
elimination from the kidneys, demands a large amount of drink, and doubts are expressed as to 
whether the c[uantity of alcohol that most people take is really hurtful. It is certain that occa- 
sional stimulation is necessary, and it is within the experience of everyone that when exhausted 
by any kind of work, with the thermometer at 90° or upwards, food, the sight of which excites 
loathing, is, after a glass of sherry and iced water or a little brandy and water, eaten with relish 
and easily digested. Although alcohol, pure or in the form of claret or brandy, does not lower 
the bodily temperature, it does, in moderate quantity, stimulate the heart's action and promote 
appetite without impairing digestion. It may enable work to be done which otherwise could not 
be performed. But each person must be a law to himself. — (II. 42.) 

According to the Keport, April — September, 1872, the cases of death by heat apoplexy, with 
hardly an exception, were due to drink-poisoning. The medical officer writes that at Hong Kew 
a mixture sold to foreigners under the name of 'gin' contains sulphuric acid, kerosene oil, and 
hang ; also that ' Hong Kew gin is an excellent blistering fluid for horses.'' He advocates the 
institution at Shanghai of a temperance establishment, in which light amusements and reading- 
shall be provided. — (IV. 103.) In that to March, 1873, it is stated that trips into the country are 
from time to time organized ; all kinds of athletic exercises practised by the majority of male 
adult foreigners ; the rules of living not notoriously lax, yefc there is hardly an individual who 
has not after a longer or shorter interval, but never a very long one, some residuum of undefinable 
seediness which disappears only after a change of climate. — (Y . 52.) 

Dr. Jamieson further writes : ' Incidentally, reference is frequently made to the evil effects of 
excess, but little has as yet been written regarding the value of alcohol, in the various 

Alcoholic Drinks. . c t .-h -\ ■ ■ ■ n i t. 

terms ot distilled spirits, wmes, and malt liquors, considered as food and as 
medicine.' He does not refer to the use of wine in continued fevers, where it forms the largest 
part of routine medication. Undiluted spirits he considers to be unequivocably bad ; spirits in a 
diluted state stimulate the mucous membrane of the stomach and augment its secretion. Hence 
the appetizing and peptic effect of a minute quantity of brandy much diluted with iced-water, 
taken shortly before eating in cases of atonic dyspepsia. On the other hand, when swallowed 
undiluted, spirits arrest the secretion of the gastric mucous membrane, giving rise to true inflam- 
matory congestion. — (V. 56.) 

July, August, and September are the hottest months of the year. The thermometer in the 

shade then occasionally registers above 100° Fahr. ; it is frequently 96° Fahr., and 

seldom falls below 90° Fahr. in the forenoon, or 80° Fahr. at night. — (II. 41 .) 

The Report for the half-year ending 31st March, 1872, contains a series of tables showing the 



LOCAL CONDITIONS IN RELATION TO PUBLIC HEALTH. 33 

variations of temperature and of rainfall from between 1867 to that date. According to tlie 
reporter, it was not possible to collect under any general law tlio sequences observed between 
atmospheric conditions and the development of certain diseases. He, however, urged the 
establishment of stations for observations of this nature. — (III. 77.) In that to 30th September 
of the same year, the reporter observes that during summer, in the town itself, the heat was 
considerably more severely felt than it was in the country immediately outside, yet that the 
thermometer-reading was the same in both localities. A portion of this difference was due to 
the custom of the Chinese of covering-in the streets with matting, a measure which is believed 
to be protective against evils that would accrue from direct exposure to the heat of the sun. 
In the ease with which this measure can be carried out lies an advantage of narrow streets, such 
as are those of Chinese towns in general. As an illustration of this, it is stated that very few, 
if any, Chinese die from the direct effects of the sun. For some days in every summer the 
temperature at Shanghai rises to or above 100° Pahr. ; ' yet we have never to chronicle results 
at all similar to those which follow a like high temperature in other parts of the world.' — 
(IV. 93.) 

According to the Report to September, 1873, the hot season is a short one, and by many 
foreigners can be avoided by a migration to Cheefoo, or by taking short sea-trips. The reporter 
observes that those who remain in Shanghai may tide over many dangers by a judicious use of 
quinine and stimulants, over and above the ordinary precautions dictated by common-sense. 
No general caution is of more importance than that of immediate attention to bowel derange- 
ment. It is remarked that during the half-year the maximum temperature, 96° Pahr., occurred in 
July.— (VI. 54-56.) 

Prom October, 1873, to March, 1874, the maximum, 76'5° Pahr., occurred in the former 
month; the minimum, 32°, in December. — (VII. 33.) Prom April to September, 1874, the 
maximum temperature, 94'5° Pahr,, occurred on the 5th of June. Rainfall was under the average. 
Although temperature was not very high, the air was laden with moisture and with ground- 
exhalations. To this much of serious illness was assigned, and the rate of mortality was above 
the average. — (VIII. 16.) 

The early part of October, 1874, was wet; November, as is usual there, was clear and cold; 
December cold. During the first quarter of 1875, the days were damp and chilly ; but, except on 
one or two occasions, the temperature did not fall much below 30° Pahr. Light rain was of 
frequent occurrence, and the second and third weeks of March were continuously wet. The 
outskirts of the settlement are constantly becoming more desirable, and it should be the object 
of everybody who possesses a suburban villa to plant as many trees as possible in his neighbour- 
hood. Trees cool the air by protecting the ground from the direct rays of the sun, by 
evaporating fluids elaborated by the trees themselves, and by cooling the strata of air in 
immediate contact with them. In the same Report Dr. Jamieson writes : 'That the summer 
temperature experienced there is not of itself the cause of serious disease is _ ^ , _. 

•f^ r _ Heat and Disease. 

manifest from the fact that our hottest summers are not those which prove the 
most unhealthy. At Bagdad the mercury often reaches 120° Pahr. in the shade, and in June^ 
1850, at a place a little south of Bagdad, it often reached 124° Pahr. ; yet the Arabs living under 
these conditions are healthy and warlike.' With reference to Shanghai, he observes that ' the 
periods at which we suffer most are the spring and fall, when the weather is changeable and 
uncertain. The dependence of disease upon change of season was observed at the time of 
Herodotus: "After the Lybians, the Egyptians are the healthiest of all men, on account, as it 
seems to me, of the seasons, inasmuch as they are not variable. Por diseases attack people 

5 



"4 EriTo:»iE OF medical reports. 

especially during changes, and most particularly during changes of weather"' (ii. 77).— 
(IX. 6-12.) 

The month of April, 1875, was throughout cold and dry; so was the first part of May, 
with the exception of one or two very hot days. From the third week of May to the end of 
June, the weather was continuously wet, with a low temperature. Severe heat began witli 
■July and continued for nearly two weeks, when the temperature suddenly fell and the wind 
changed from west to south. The temperature quickly rose again, and continued high, day 
and night, till the end of the month. Throughout August, heavy rains with moderate tempera- 
ture prevailed ; September was cool and dry. — (X. 55.) According to the Eeport for the six 
months April — September, 1877, no satisfactory connection could be traced between the meteor- 
ological record and the disease record. In the months of June, July, and August, the amount 
of ozone was small • but the smallest monthly maximum was in September, at which time 
cholera prevailed. It was believed by the older residents of the place that the summers have 
of late years become milder than formerly, and the observation is to some extent corroborated 
by meteorological records. It is considered, however, that newly-arrived foreigners continue, as 
they have always done, to suifer more from the effects of climate than they do in subsequent 
years. The summer of that year was characterized by sudden alternations of heat and cold, 
with frequent rains. It was described as essentially treacherous ; and both sickness and mortality 
were unusually high. — (XIY. o7.) In reference to the climatic characteristics of Shanghai — - 
from observations (1877-78) there appears to exist in the upper strata of the atmosphere a 
strong air-current flowing almost exactly eastvs^ard. During 1877 this current was very con- 
stant. By some meteorologists it is considered to be a bifurcation of the return trade-wind 
which blows usually from S.W. to N.E. The winter of 1877-78 at Shanghai was the most 
severe that had recurred since 1801-62. It does not appear, however, that mortality was 
swelled by its severity. In the early part of 1877 a new hospital was established on the 
bank of the Soochow creek. All arrangements connected with it, and as regards the sisters 
in attendance, were placed on a satisfactory footing. — (XV. 2.) 

During the summer of 1878, the temperature was never very high, nor were the nights 
remarkably hot ; yet old residents were unanimous in considering that season as one of the 
most trying in their experience. — (XVI. 31.) In the six months ending GOth September, 
1879, the season was unusually hot. On 16th of August the temperature was at its highest 
point, namely 99° Pahr. in the shade; from 10th to that date, at no time under 80° Fahr. 
Cases of heat apoplexy were then of somewhat frequent occurrence. — (XVIII. SJ.) In 1880, 
the temperature during the summer was unusually mild ; no night sufficiently hot to prevent sleep 
in a well-ventilated apartment. To this circumstance was attributed the absence of all affections 
depending upon excessive heat, and also the low death-rate of the period. — (XX. o3.) The latter 
half of October was dry and windy; the lowest temperature 42-8' Fahr. at 6 a.m. on the 26th. 
November and December were dry, clear, and cold ; the mean daily temperature during nine 
days of the latter month, below u2° Fahr. ; the average temperature during the entire month, 
37'7G° Fahr. The latter half of January, 1881, and all February, with the exception of three 
days, were cold and tempestuous. On these three days the thermometer indicated respectively, 
62-8° Fahr., 70-7° Fahr., and 78-25° Fahr. March was wet, windy, and cold, until the last 
week, when the temperature oscillated about 60° Fahr. — (XXI. 80.) The summer season, of 
1881 was distinguished by its violent and constantly recurring atmospheric disturbances. 
Every month was stormy, and from May to September typhoons prevailed there and upon 
the China coast generally. April was unusually rainy, and the weather did not clear up 



LOCAL CONDITIONS IN RELATION TO PUBLIC HEALTH. 35 

permanently during the entire season. The range of temperature was very wide, cold nights 
being succeeded by hot daysj the atmosphere was laden with moisture; the rainfall 37 inches, 
taking place on 77 days; highest point attained by the temperature, 97" Fahr., namely on 
25th July.— (XXII. 51.) 

In the six months ending September, 1871, it is recorded that the European and other 
foreign members of the police force were remarkably healthy. They were kept in barracks 
during the heat of the day when practicable j on duty they were guarded as 
much as possible from the sun. In barracks they were provided with punkahs, 
and had unlimited supply of ice. They could obtain coffee and other beverages at any hour 
during the night. — (II. 38.) 

According to the Report for the half-year ending 31st March, 1872, there may be, and is in 
fact, little alteration in the death-rate as roughly estimated from year to year, but there is a 
marked diminution in the amount of general ' seediness ' arising from more or less slight 
hepatic derangement, or absorption of malarial poison. The malignant 'Shanghai fever'' has 
almost completely disappeared ; intermittents and neuralgia are becoming slovvly less prevalent. 
The general health of the population, and of the several classes of foreign residents, was 
favourable. In the same Report, the medical officer observes that the reputation of that 
settlement for healthiness has undergone many changes. At one time it was regarded as the 
sanatorium of China, but after a few years' residence there was declared to be more dangerous 
than at any other port in the East ; and this evil reputation, never very just, still, at that date, 
clung to the station. Yet the return of causes of death among foreign residents shows that in 
the majority of cases the climate pure and simple cannot be charged with the event. He 
further remarks that a number of diseases which prevail in England are at Shanghai unrepre- 
sented ; among them, diphtheria, croup, scarlet fever, true measles, laryngitis. ' "Without, 
therefore, attempting to assert that Shanghai is the best place of residence in the world, we may 
say, at least, that, presuming ordinary care to be taken during the heat of summer, nobody 
diminishes his chance of life by leaving England and removing to this port.' — (III. 78-86.) 
In the summer of 1872, the diminution of ' malignant remittent fever ■" noticed in a previous 
Report gave way to ' many instances of the disease.' During the six months ending oOth 
September, the health of the Customs staff was good. Among the children in the Eurasian 
school, such of them as were strumous when taken into that institution rapidly improved in health 
therein. Among children the mortality was comparatively large. The English portion of the 
police force suffered comparatively little from illness, a circumstance due to the care taken in 
selecting the men. In the French portion of the same force, out of a strength of 47 men, 19 
were ill during the period. There can be little doubt that the more than tropical heat of summer 
interferes with the growth and development of adolescents. Dr. Jamieson alludes to the 
imprudence of retaining children here for a longer time than is absolutely unavoidable, and of 
sending out young men who are still growing to encounter the constant work of a Shanghai office 
and the vicissitudes of a Shanghai climate. Although people may keep well for an indefinite 
period, should they once become seriously ill it is almost impossible for them to convalesce here. 
After the severer forms of periodic or continued fever, a trip to Japan or to some other port is 
not only desirable, but absolutely indispensable. It is impossible that Shanghai can ever be a 
desirable residence for children or youths. — (IV. 94-105.) 

In his Report to March, 1873, he writes '' that the risk to life is not inordinately great in 
Shanghai. We have no periodical epidemic, such as those of typhus and small-pox. Nor is the 
climate so fatal to child-life as that of India ; indeed, in some respects, children in Shanghai 

5—2 



36 EPITOME OF MEDICAL REPORTS. 

would seem to be more favourably situated than cliildren in Europe.' — (V. 54.) In the half-year 
ending 30th September, 1873, no serious case, except one of hepatic abscess, occurred in the 
Customs staff.— (TI. 58.) In the last three months of 1873, there was an unusual amount of 
sickness, apparently due to frequent and sudden changes of temperature. — (VII. 34.) In the 
six months from April to September, 1874, the health of the Customs staff was fairly good. 
- -(VIII. 17.) According to the Eeport to March, 1874, much disease, severe in type, prevailed 
among Chinese and foreigners. The Customs staff, however, upon the whole, were tolerably 
healthy. Adverting to the general subject of health. Dr. Jamieson writes : ' The ratio of deaths 
between 20 and 30 to the total number of deaths is here far larger than in Europe. The ratio of 
deaths from diseases of the heart and great vessels to the number of deaths from all causes 
is here higher than in Europe; but very many of the diseases which are annually fatal in Europe 
to large numbers of men at the ages chiefly represented here are unknown. The health reputation 
of a place such as Shanghai very much depends upon the inhabitants themselves.' — (IX. 7-11.) 
In the half-year ending 30th September, 1875, the health of the Customs staff was fairly good. 
On the subject of personal hygiene. Dr. Jamieson recommends that as clothing, light, somewhat 
loosely-textured flannels are the coolest for summer wear. He accords credit for good 
Temperance work to the Temperance Society in operation at that settlement. He is much 

Society. mistaken if the energetic good works of the Temperance Society there established 
do not, year after year, tell more and more upon the condition as regards health, not only of 
sailors visiting the port, but of that large and constantly increasing body of Europeans who pick 
up an honest livelihood somehow. — (X. 55-61.) From October, 1875, to March, 1876, notwith- 
standing that considerable sickness prevailed in other communities, the health of the Customs 
staff remained good. — (XI. 50.) 

In the Report to 30th September, 1876, Dr. Jamieson writes : ' Experience in Shanghai is 
tolerably uniform as to the excellent condition of health preserved by old residents who take good 
care of themselves, who avoid excesses, and who have been lucky enough to escape malarious 
fever. Even amoug those who in their earlier days suffered from periodic fevers, there are many 
who appear to have outlived their susceptibility to them. There are many foreign residents who 
have lived twenty years and upwards in China, and of them the majority would compare favour- 
ably for strength and endurance with a like number of the same age taken from the desks of 
London oflices.' He observes that men belonging to ships fresh from European and American 
ports are often found in hospital suffering from advanced heart disease, aortic aneurism, chronic 
disease of the kidneys, or who are in the last stage of phthisis. He remarks on the necessity of 
carefully inspecting seamen when first shipped, as intended by the framers of the Merchant 
Shipping Bill of 1876. — (XIII. 3, 8.) In the Eeport to March, 1878, a comparison was drawn 
between the rates of sickness and mortality at this place and in India. In 1876 the ratio of 
deaths among English troops in India was equal to 15'32 per 1,000 ; among ofiicers to 14'8. 
These figures are believed to contrast favourably with Shanghai. In India the mortality among 
soldiers' children for that year was 55'38 per thousand; of those under one year 215. At Shanghai 
the mortality among children was inconsiderable. — (XV. 4.) The summer of 1878 was unusually 
unhealthy, not so much, however, as regards residents on shore as the classes on board ship. — 
(XVI. 31.) During the six months ending March, 1879, the health of the foreign residents was 
good; they suffered comparatively little from endemic diseases, and their children were absolutely 
free from some of the diseases that are most fatal among children in Europe and America. — 
(XVII. 20.) 

During the six months ending September, 1871, the diseases which most prevailed among 



LOCAL CONDITIONS IN RELATION TO PUBLIC HEALTH. 37 

foreign residents were ttus enumerated : a, those assigned to climatic causes^ hepatitis, and 
dysentery; h, to local causes, typhoid, and small-pox; c, to the action of the sun and personal 
habits, typhus, sunstroke, delirium tremens, meningitis. Hepatitis was distributed 
evenly through five months. May being excluded. In each month from April to 
July there was a case of typhoid. Diarrhoea and dysentery occurred throughout the period. 
Typhus occurred in May, August, and September; intermittent, remittent, and 'bilious^ fevers in 
each month from May to September, both inclusive. Small-pox disappeared in May. Disease 
in August appeared to be more fatal than in the other months. The prevailing type of disease 
was periodic, and this extends to diseases presumably not of malarious origin. Shanghai is one 
of the homes of remittents and intermittents, a violent type of the former being known as 
' Shanghai fever.' Hepatitis and dysentery combined are of frequent occurrence. During the six 
months under notice no epidemic disease of importance occurred. Whooping-cough, as to the occur- 
rence of which previously no record occurs, was imported from Hankow in April, and ran through 
several families. Pung-sha, a cuta.neous epidemic, prevailed this year. It affected large numbers 
of natives and foreigners, including adults as well as children. It prevailed chiefly during the 
months of September and October. The relation between high temperature, April to September, 
and increased mortality is indicated. In the winter of 1871-72 no epidemic prevailed. — (II. 37-41.) 
A few cases of fung-sha occurred in October and November. Some cases of phthisis were 
imported, but the disease seldom, if ever, originates here, and such cases as arrived from else- 
where benefited by residence at the settlement. Dysentery is endemic. — (III. 79.) 

In his Report to 30th September, 1872, Dr. Jamieson hopes that means may be adopted 
whereby the results of private practice may be laid before the profession. He records the occur- 
rence of that malignant type of remittent fever indicated respectively as ' mixed •" or ' Shanghai ■" 
fever. Typhoid and typhus fever occurred, but dengue, prevalent at Amoy in August and 
September, was not observed here. Dysentery was not represented in April or May ; no case 
of chronic diarrhoea appeared during July, August, or September; acute diarrhoea was ad- 
mitted only in July and August ; typhoid only in August and September ; intermittent fever was 
absent in May, June, and September, and, ' curiously enough, the four cases of typhus occui'red in 
May and June before the onset of hot weather.' — (IV. 92, 94, 100.) In discussing this subject 
the medical officer alludes also to the question of rise or fall of the temperature of the body in 
accordance with that of the atmosphere. In reference to certain reports on the subject, he states 
that his observations show that his own temperature under the tongue was during the hottest 
part of that summer 99'4° Fahr. to 998° Pahr. ; during mild and cool weather it was persistently 
99'2° Fahr. Venereal diseases of various kinds and severity were somewhat prevalent. Variola 
is never altogether absent from the native quarters. One case of small-pox occurred among the 
police in April, another in July. The diseases which occurred among members of the Customs 
staff were bilious diarrhoea, febricula from exposure to the sun, intermittent fever, neuralgia, and 
boils.— (IV. 101, 105.) 

According to the Report to 31st March, 1873, the amount of brain disease encountered in 
Shanghai has lately assumed formidable proportions, and threatens to rival in importance diseases 
of the circulatory system. Dysentery within the last two years has become less frequent and less 
fatal; typhoid is rising in importance; hepatic abscess not uncommon. Other diseases enume- 
rated include malarial fevers, phthisis, heart disease, small-pox, etc. During the period thus 
included an epidemic of a mild form of measles attacked the children in the Eurasian school. 
The reporter has never seen scarlet fever in China. Only one case of diphtheria has been seen at 
this place. Whooping-cough, which has appeared only within the last few years, is usually of a 



38 EPITOME OF MEDICAL EEPORTS. 

mild type.— (V. 53, 55.) In tlie Report to 3rd September, 1873, allusion is made to tlie ' alarm- 
ing frequency and fatality of diseases of the circulatory system among foreigners in China. 
Dysentery and typhoid fever are here constantly lying in wait for the unwary. ' Safety lies on 
the side of assuming that both may arise without the implantation of a specific poison derived 
from a previous case of the disease.-* Severe inflammatory diarrhoea is often produced without 
ascertainable cause other than a sudden fall of temperature, especially with a high proportion of 
aqueous vapour in the atmosphere. — (VI. 55, 56.) During the six months ending 31st March, 
ly74', acute dysentery, acute diarrhoea, remittent and intermittent fevers, typhoid and rheumatism, 
were of frequent occurrence, while minor ailments, such as neuralgia, lumbago, catarrh, sore 
throat, etc., were daily brought under observation. Small-pox did not appear till 29th of 
December, and then only one case occurred, namely in a child arrived from Chefoo. Several 
cases of abscess of the liver occurred, in one instance the affection being consecutive to acute 
dysentery. A few deaths from typhoid and a few from small-pox occurred. Whooping-cough 
attacked several children, but hardly as an epidemic. A true epidemic of varicella joassed over 
the settlement in February. — (VII. o-J.) 

During the summer of 1871, malarial fever and dysenteric diarrhoea prevailed, the latter 
especially among children after the beginning of June. No epidemic of small-pox or chicken- 
pox occurred, nor was there any actual epidemic in any form j yet nearly all the foreign residents 
suffered from some degree of gastric derangement. Remittent fever of a typhoid character pi'evailed, 
often associated with hepatic congestion. — (VIII. 16.) In October, 1874, disease of very serious 
character was rife. It was so also in the fii'st half of November, but could not be attributed to 
meteorological conditions. In the first months of 1875, bronchitis, neuralgia, conjunctivitis, 
rheumatic affections, coughs, and sore throats were common. Malarial fevers, dysentery, and 
diarrhoea occurred, and among the native Chinese small-pox was very prevalent. — (IX. 7.) 
From April to September, 1875, small-pox and measles prevailed. During the entire period fever, 
periodic, and a few typhoid in type, diarrhoea, dysentery, rheumatism, hepatic congestion, 
neuralgia, boils, and colds, made up the sick-lists of the settlements. In the month of August a 
severe and often fatal form of bowel affection with vomiting and cramps occurred among the 
natives, suggesting the possible outbreak of cholera. — (X. 55.) From October, 1875, to March, 
] 876, cholera and measles occurred as epidemics ; malarial fevers prevailed : there was an increase 
in tijphoid. Throughout the winter bronchial and intestinal catarrh, dyspepsia, hepatic conges- 
tion, rheumatism, and neuralgia were common. — (XI. 50.) During the six months ending otith 
September, l87(i, the prevailing diseases were dysentery, and diarrhoea, remittent and inter- 
mittent fever, febricula (commonly due to excess and exposure to the sun). — (XII. 2.) During 
the half-year ending 31st March, 1877, the prevailing diseases were malarial fevers, chest 
affections, small-pox, dysentery, and diarrhcua. During the month of October several cases of 
sun inoliiise occurred, but the affection was usually linked to some error in diet. Among children 
there was an epidemic of what would have been mumps if the glandular swelling had been 
attended by fever, which it was not.— (XIII. 14..) The winter season of 1877-78 was the most 
severe that had occurred since 1861-62. Mortality did not appear, however, to increase in con- 
sequence. The first case of small-pox for the season occurred on 8th of December ; a very few 
happened from that date till 8th of February. — (XV. 2.) In the six months ending September, 
1878, the only noteworthy occurrence was a brief and slight visitation of cholera. — (XVI. 32.) In 
February and March, 1879, an epidemic of chicken-pox, chiefly affecting children of foreigners, 
' rushed through the settlement.'— (XVII. 21.) With regard to the six months ending oOth 
September, 1879, it is stated that except absolutely preventiblc di.seases, as alcoholism and sun- 



LOCAL CONBITIOXS IN RELATfON TO PUBLIC HEALTH. 39 

stroke, the rate of mortality ' for the most trying months of a most trying j'car was far from 
alarming.' — (XVIIT. 82.) In 1880 small-pox prevailed among the shipping as late as the month 
of May. Severe cases of measles were observed, but the disease did not become epidemic. 
As usual, during the continuance of hot weather mortality among natives, vaguely described as 
regards its cause, occurred.— (XX. 33, 34.) Daring the half-year ending 30th September, 
1881, the mortality was unusually high. Of the diseases by which it was chiefly caused, those of 
the nervous, circulatory, respiratory, digestive, and urinary systems were but remotely, if 
at all, influenced by climatic conditions. Eeference is also made to ' that extremely acute and 
fatal form of gastro-enteritis which is known as cholera, and which now invariably presents itself 
here during late summer and early autumn.' Diphtheria, enteric fever, and dysentery were also 
among the fatal diseases. — (XXII. 53.) 



NINGPO. 

Situated in lat. 29° 51' N., long. 121° 32' E. ; on the banks of a river, 12 miles from the 

sea. It is surrounded by an alluvial plain, nearly encircled by hills. This plain 

has a diameter of 20 to 30 miles. It is intersected everywhere by canals and 

irrigating ditches for the cultivation of rice, for which the fields are kept flooded with water from 

June to the end of October. — (XX. 30.) 

In the Report to 31st March, 1874, reference is made to 'the enthusiasm of Mr. Alabaster 
in furthering drainage and the formation of a bund, both of which are greatly 
wanted. They will be of great benefit in a sanitary point of view to the settlement.'' 
• — (VII. 25.) In the year ending 31st March, 1878, the sanitary arrangements had undergone a 
great improvement compared to what they had been in previous years. — (XV. 21.) 

In the half-year ending 31st March, 1873, the highest temperature, 70'17', occurred in 
the month of October; the lowest maximum, 42'24° Fahr., in January. The 
maximum of the lowest monthly readings, 65'04° in October; the actual minimum, 
36'08° in January. — (V. 25.) In the year ending 31st March, 1870, the greatest rainfall took 
place during the months of May, July, August, and September of 1875, and January, 
February, and March of 1876. April, October, November, and December of 1875 were very 
dry and fine months. In the whole twelve months the absolute maximum monthly tempera- 
ture, namely 98° Fahr., occurred in July ; the lowest maximum, 49° Fahr., in January. The 
highest minimum, 70° Fahr., in August; the absolute minimum, 22° Fahr., in January. — (XI. 28.) 
The winter of 1877-78 was long and severe; snow remained for a great number of con- 
secutive days, and all canals and ponds were frozen ovei". The lowest temperature was 18° 
Fahr., namely on 8th January, at 4 a.m. ; the greatest heat in the shade that month 66° Fahr., 
at !■ p.m. of 26th. — (XV. 21.) The summer of 1880 was cool and moist. For the four months 
from June to September, the thermometer showed a mean maximum of 81 '2°, and a mean 
minimum of 75 '3°. Rain fell on 53 days during the period. Wind was generally from the 
south. In July and September winds were variable; in August, from the north. — (XX. 30.) 
In 1881, the mean maximum temperature of the four months, June to September, was 8r3° ; 
the minimum, 72 "7°. Sea breezes prevailed in June; they gave place to land winds in July, 
but returned in August and September. During these four months rain fell on 36 days. — 
(XXII. 13.) 

In the Report for the half-year ending March, 1873, Dr, Mackenzie wrote that ' not- 



40 EPITOME OE MEDICAL EEPORTS. 

withstanding the imperfect drainage of the settlement, and the great changeableness of the 
Health and Weather, there was remarkably little sickness during the winter months. The 
Diseases. diseases most prevalent were diarrhcsa and dyspepsia, both of mild type. A 
few cases of intermittent fever occurred, one of dysentery, and two deaths by enteric fever. — 
(V. 25.) The year ending 31st March, 187-1-, was healthy as regards foreign residents. Diar- 
rhoea and dyspepsia were the most frequent diseases, but within June and July some cases 
of dysentery occurred on board ships in harbour. In the months of December and January 
an epidemic of scarlatina and measles of a virulent type raged among the Chinese in the city, 
many of the ill-fed and closely-packed natives falling victims. A little later on several 
foreigners were attacked, but all recovered. In August, apprehensions were entertained of an 
invasion of cholera from Siam; that disease, however, did not break out. The Sisters of Charity 
admitted some Chinese suifering from frost-bite in winter, that season being a very severe one.' 
— (VII. 24, 25.) In the year ending 31st March, 1876, the health of the foreign community waa 
very good. ' As usual,' the predominating complaints were diarrhoea and dyspepsia, the former 
in June, July, and August, the latter throughout the year. Several cases of vomiting and 
purging from eating shell-fish. A few cases of dysentery. Only one case of small-pox. — 
(XI. 27.) During the year ending 31st March, 1877, the health of the foreign residents was 
remarkably good. This was in a great measure due to the coolness of the summer of 1876. 
Intermittent fever was less prevalent than it had been during the previous year. No cases of 
syphilis came under observation, and but few of gonorrhcea. — (XIII. 46.) In the six months 
ending September, 1877, the health of both foreigners and natives continued remarkably good, 
due again to the coolness of summer. Diarrhoea, as usual, prevailed most in June, July, and 
August. In the early part of May, several cases of heat malaise occurred. Up to the end of 
September, cholera had not visited Ningpo, although many cases of that disease occurred both 
to the south and north of the settlement. — (XIV. 65.) In the six months ending March, 187S, 
the foreign community had little to complain of as regards ill-health. In October and 
November, 1877, several cases of diarrhoea and of dyspepsia came under notice. In winter, 
bronchitis was severe; gonorrhcea more prevalent than usual, but no case of syphilis. — (XV. 
21.) In the year ending 31st March, 1879, the health of foreigners compared favourably with 
past years, but among the natives the death-rate was larger than usual, owing to an epidemic 
of cholera. Of prevailing diseases, diarrhoea heads the list ; rheumatic cases were more 
numerous than usual ; intermittent fever not so frequent, although most complaints exhibited an 
intermittent character. Gonorrhoea was not prevalent. An epidemic of cholera and an outbreak 
of cattle disease were contemporaneous. This epizootic appears to have been at its height in 
September and October. — (XVII. 6.) In his Report on this settlement for the eighteen mouths 
ending 30th September, 1880, Dr. Henderson remarks upon the abseuce of the habitual deposit 
of urates in the urine of the community, as compared with its frequency in Chefoo. Among 
the prevalent malarial disorders are neuralgia, recurrent diarrhoea, enlargement of the liver and 
spleen, ansemia with nub-nonnul temperature, and fever, remittent and intermittent. Durino- 
the above hot season, few patients had escaped fever. That which prevailed among foreigners 
was of the remittent type. During the heavy rains of June, when vegetable growth was active, 
and the minimum amount of waste matter was in the surrounding paddy-fields, there were no 
cases of fever among the foreigners. In July, three cases occurred; in August, eight ; and 
from then the numbers rapidly increased, until in the middle of October nearly the whole com- 
munity was affected. In October, fever became also very prevalent among the natives, 
prostrating them in such numbers as to cause difficulty in regard to gathering in the crops, — 



LOCAL CONDITIONS IN RELATION TO PUBLIC HEALTH. 41 

(XV. 27, 30, 31.) The hot season of 1881 was described as having 'been extremely healthy for 
such a locality as Ningpo.' In June and July, the usual malarial fever appeared, but in August 
and September there was little of it. Diarrhoea existed through these months, but chiefly in 
July. The excellent health of the community was assigned in part to the prevalence of sea 
breezes throughout the season, and partly to the low temperature of the season.— (XXII. 13.) 

WENCHOW. 

Wenchow is situated in lat. 28° 1' 30" N., and long. 120° 38' 28'50" B. It lies on the south bank 
of the Ou-kiang, which flows between long ranges of hills N. and S. down to the „ 

mi, -J. ill <3 o Topography. 

sea. Ihe city appears to have been arranged with due regard to ' sanitary laws :' 

streets regularly laid out and paved ; their roadways sloping on either side towards gutters, and 

these in turn communicating with canals which run throusrh the citv- At intervals „ . 

1 , . ° •' Samtarv Laws. 

along the streets are latrines and urinals, their contents emptied in the early 
morning — either destroyed by fire or utilized for the fields. The canals are periodically dredged; 
the people well-to-do ; population not excessive in proportion to occupied area. There are 
numerous joss-houses, each surrounded by large open spaces ; thus the general purity of the 
air is improved. Throughout the city there are many well-raised houses, their windows of glass, 
their floors raised. The city is enclosed by a circle of small hills, along the summits of which the 
walls run. The ground within these is considerably elevated above the river, hence inundation or 
flooding is unknown. On the plain extending from the base of the large hills forming the south 
side of the valley, up to the walls of the city, rice is largely cultivated, irrigation taking place from 
the canals already noticed. Shut out as these fields and canals are from the city by means of the 
wall, no injurious effects take place. The chief article of foreign trade is tea ; for import, piece 
goods, opium, oil, etc. — (XV. 38-43.) Further information in reference to Wenchow occurs in 
the Report on that place for the half-year ending 30th September, 1881, thus : ' Wenchow is a 
departmental city, containing a population of 80,000 to 90,000, with tributary districts swelling 
that number to 500,000. It is situated 15 miles from the sea^ on the right bank of the Pungsha, 
or Ou river. In the neighbourhood of the city, and extending far inland, what were once 
marshes now constitute a chief portion of the land. This paludal region is begirt, except 
seaward, wich pine-clad hills, and is now a fertile rice country.' — (XX. 14.) 

Interments do not take place within the city, except in few instances. Decomposing animal 
or vegetable matter is not to be met with. The perfect system of drainage obviated ^ 

o r J a Conservancy. 

many of the disadvantages of the wet season. — (XV. 39.) 

The people are careful as to the water they drink. They draw their supply from wells dug in 
places as remote as possible from habitations. These are further secured by 
encircling walls closely cemented, so as to keep out the surface drainage. This is 
used for potable purposes, canal water being used for washing. — (XV. 39.) 

In 1877-78, the newly-arrived Europeans experienced inconvenience from the want of beef. 
That sold in the market for Chinese consumption was of the most objectionable kindj being 
generally procured from the carcases of animals that had died of disease, or had been 
slaughtered in anticipation of the event. This state of things speedily changed for 
the better, good beef, and occasionally mutton, having been obtained. In the cooler weather 
goat-mutton was obtainable. Geese, ducks, and vegetable were plentiful. Pigs are carefully 
kept in sties, and are well fed and cared for. — (XV. 40.) 

C 



42 EPIT03IE OF MEDICAL KEPORTS. 

The year ending March, 1878, was exceptionally wet. All over the south of China, wet 
weather scarcely ceased from June of last year to January of this. The summer heat was 
pleasantly tempered by sea-breezes. — (XV. 39.) According to the Report, April — 
September, 1881, it has a greater number of rainy days than any port in the 
Chinese Empire, ' mtdgre the deforestizatiou, which here, as in the United States, does not seem 
to have had any hygrometric effect.' It has a rainy season extending from the middle of May to 
September. During the other months of the year rainy days are of frequent occurrence. Yet, 
' for foreigners, it is probably the healthiest part of China. Its summer heat is mitigated by the 
rains and sea-breezes, and in winter it seldom descends to freezing. A northern invalid may here 
inhale an admirable alterative, while invalids from the south may here escape the blasts of higher 
latitudes. In fine, Wenchow possesses the climate of Nice without a misfral' Unfortunately, 
this port has no suitable accommodation for patients. The vegetation of the place unites that of 
the warmer and colder zones. The peculiar kind of orange, the Wenchow bitter orange, flourishes 
here. It is a delicious stomachic. The bitter principle is contained in the membrane which 
subdivides the pulp ; the pulp itself is sweet. But the region is subject to floods from the 
mountains and cyclones from the ocean, storms that lay waste fields and induce famine and 
pestilence. Dr. MacGowan gives an enumeration of storms, floods, droughts, and famines from 
A.D. 291 to 1858. In the Report for the half-year April— September, 1881, he states, in a note 
dated January, 1882, that 'the year just closed was remarkable for the extraordinary number of 
typhoons, cyclones, and fogs which prevailed at that place and elsewhere on the coast of China.' 
Coincident with the exceptional season has been an unusual number of epidemics in Kiangsu and 
northern Chehkiang — autumnal diseases being rife, children chiefly suffering ; while about the 
beginning of December puerperal fever raged in Soochow. Many cases were incurable, 
and within ten days ' several tens ' of recently-delivered women succumbed to the prevailing 
epidemic— (XXII. 14-50.) 

In 1877-78, the great depression and languor complained of so much in most up-river places 
was felt here to a very limited extent, if at all. On the contrary, thanks to the sea-breezes. 
Health and residents often experience an exhilarating and bracing effect of the climate. 
Disease. General good health prevailed among the foreign community. The Chinese were 
' shy of coming under foreign treatment, and entertain most peculiar and contradictory notions as 
to its capabilities.' Ague from country districts occasionally appeared. Eye diseases were 
common. Small-pox was not remarkably prevalent. Vaccination was not practised. Cholera 
prevailed for ten or fourteen days in August, 1877 ; opium-smokers, when attacked, almost certainly 
died. Elephantiasis cases are not numerous. Skin diseases are very general, scabies most of all. 
Euthetic diseases very plentiful. — (XV. o'J, 40.) In August, 1878, a slight recurrence of cholera 
took place. Among the natives 'the utter absence of all treatment undoubtedly tended to swell 
the mortality rate.' During the year ending March, 1879, the health of the foreign community, 
numbering only 26 persons, was generally very good. — (XVIII. GO.) The physique 
of the inhabitants compares unfavourably with those of other portions of the 
Chinese Empire. They are described as of delicate frame, insignificant physiognomy, and small- 
brained. Fewer attain to 70 years of age than in adjoining departments, and, as in southern 
Chehkiang generally, it is seldom that scholars succeed at the provincial examinations. The 
religious orders are credited with contributing greatly to the perpetuation and dissemination of a 
contagious disorder. They are largely addicted to the use of opium. Situated as Wenchow is on 
a reclaimed marsh, reticulated by canals, it is the abode of intermittent fever. That disease 
prevails in every spring and autumn^ especially affecting new-comers. Cholera has repeatedly 
visited the locality.— (XXII. 22.) 



Topograpby. 



LOCAL CONDITIONS IN RELATION TO PUBLIC HEALTH. 43 

FOOCHOW. 

FoocHOWj the capital of the province of Fukieu, is situated on the left bank of the river Min, in 
lat. 25° 58' 22 N., and long. 119° 27' 40" E. According to the classification o 
regions as zones of vegetation, that of Poochow is sub-tropical. Along the Yung-fu 
branch of the Min, and on the main river to Shin-kao, the scenery is very beautiful, and often 
grand. The hills vary in height from 100 to ;J,000 feet, and run parallel with the river. 
The general geological structure is conglomerate ; that of the highlands mostly of granite. No 
marshes exist. The lowlands are rich alluvial plains in the highest state of cultivation, and yield 
two crops of rice and one of barley a year. The valley of the Min is one of the most fertile parts 
of China. The richness of the soil is maintained by careful manuring, and by means of the rich 
alluvial deposits from the creeks, these being spread over it. The fields are ' watered ' with 
night-soil, a practice which gives rise to veiy offensive odours ; but the men and women 
employed in the process appear smiling and robust, nor can the reporter learn that they take any 
harm from their unsavoury occupation. — (VII. 7.) 

According to the Report on that place for the year ending ;31st March, 1881, the foreign 
settlement, distant 25 miles from the mouth of the river Min, is planted on hilly ground on the 
right bank of the north branch of that stream, and on the north side of the island of Nantai. 
The valley of the Min is intersected by numerous canals and creeks. During the rainy season the 
Min overflows its banks, and then covers the country like a lake. For eight months of the year 
the plain, manured with night-soil, is almost devoted to two crops of rice. In some parts, during 
the cold weather, a crop of barley, wheat, or beans is raised ; the remainder, more or less 
swampy, is left at rest. The hill on which the foreign settlement stands is about 100 feet above 
the level of the plain ; on one side it is .skirted by the river ; otherwise, except on its western aspect, 
it is bounded by rice-fields. Its position is lat. 26° 5' N., long. 119° 20' E. On the river, a little 
above the settlement, several thousands of boat population find an anchorage. The city, which is 
walled, contains about 500,000 inhabitants. It is remarkably dirty; streets narrow and filthy, 
except when washed by heavy rains. They are paved with granite. Along the centre of each 
is a narrow drain, which receives everything. Night-soil is scrupulously collected, and applied 
to fields and growing crops. In the summer season, when the country is clothed in vegetation, 
beautiful views in all directions may be obtained from the settlement. For those suffering 
from enervation and the cramped conditions of settlement life, there are at all seasons excel- 
lent retreats. On the prominent headlands where the Min joins the sea at Sharp Peak, those 
depressed by summer heats may enjoy refreshing sea-breezes and cool nights. During the 
cooler months there is every facility for excursions up the main river and its branches. There, 
mountain scenery of great beauty and grandeur abounds. Bamboo, many varieties of coniferse, 
ferns, and all sorts of flowering shrubs and plants adorn the slopes, and dispersed over the 
mountains are many varieties of game. Lately the community of Poochow has acquired a piece 
of land as a recreation-ground. — (XXI. 50-52.) 

The monastery of Kushan is situated in the midst of lovely scenery at an elevation of about 
1,400 feet above the level of the sea. The air at that place feels fresh, balmy, and ' light,' and one 
never experiences the languor and depression of the lower grounds. 'If only 
tolerable accommodation were to be had, few pleasanter places could be desired by 
those who are fortunate enough to be able to leave the river during the hottest months ; and it 
has always been matter of surprise that an intelligent and influential community like that of 

6—2 



a EPITOME OF MEDICAL REPORTS. 

Foochow lias not long ago established a sanatorium ou a mountain within such easy reach of the 
settlement.' In 1874 the only quarters available at Kushan were confined and dirty. The 
houses were wood and plaster structures built on piles^ the foundations occupied by rubbish and 
filth. Yet so much was the locality appreciated that these objectionable rooms were engaged 
every year long before the hot weather had set in. — (VIII. 63, 64.) In 1875, Dr. Somerville 
wrote : ' New rooms are being built for next season, and the nuisances indicated, removed. 
He urged the advisability of making further additions and improvements in connection with the 
accommodation at that place. He points out that the difference in temperature at Kushan and 
Foochow is 7° Fahr. in favour of the former.— (X. 36, 35.) In 1881 Dr. Eennie observed that 
the mountain on the side of which the monastery stands is itself 3,000 feet in height. — (XXI. 52.) 
In his Report from October, 1872, to March, 1873, the writer says : ' Our creeks difi^er only in 
degree (in the worst parts of the city they do not differ at all) from the San-t'sung described by 
Dr. Wong (at Canton). There is nothing like drainage, and the trafiic in night-soil^ 
the formation of manure-pits and the watering of the fields with liquid manure, 
obtain here as elsewhere ; in short, we have all the generally recognised factors of zymotic 
disease, with a high temperature to favour the fermentative and putrefactive processes. Yet we 
enjoy a high standard of health, and there has been no epidemic affecting foreigners at this port 
for at least eleven years.' — (V. 41.) 

In reference to the prevalence of diarrhoea on board ship at Foochow in the summer months. 
Dr. Somerville writes : 'What is the cause of it ?' He adds, ' It certainly is not the water. 
Ships carry water from Hong Kong, from Shanghai, and from home,' and 
he observes no difference in the number of cases. He had not noticed fewer cases 
of diarihoea in vessels using condensed water only. Gunboats use condensed water alone, and 
they have much diarrhoea. The residents at Foochow have drunk the water of the river for 
years without injury. Dr. Somerville thinks ' there is a growing opinion in the profession, 
especially entertained by those who have much experience in tropical and sub-tropical countries, 
that water containing organic matter has been too heavily blamed as the cause of disease.' He 
quotes from Morehead that 'unsuitable food, impure water included, may excite dysentery; but 
it is not a common cause ("Disease in India," p. 575). In the journals of David Liviugstone he 
observes only two instances in which disease was traced to the water used.' — (X. 43.) The 
Report to March, 1881, states that water is obtained from wells, and from the adjoining river; 
from either source it is of doubtful purity. Here, as elsewhere, the Chinese seldom drink water 
'that has not been cooked.' — (XXI. 51.) 

With regard to habits and modes of life of the several classes at Foochow, foreigners (1871) 
were considered to be the better of generous diet and a fair amount of stimulants 
at meals. Light claret was stated to be the best beverage. Malt liquor did well 
with some persons, but disagreed with others. No general rule can be laid down ; each must 
judge for himself. In the hot season, svioMng, except in extreme moderation, is injurious. In 
cases of great bodily or mental anxiety a cigar, however, to the smoker is invaluable. — (II. 29.) 
The Report to March, 1881, states in reference to the natives that the staple articles of their diet 
are rice, sweet potatoes, salt-fish, and pickled cabbage. Wheaten flour, pork, goat, and beef, are 
luxuries of the rich. — (XXI. 51.) 

The summer of 1871 was described as having been extremely mild. The actual tempera- 

Ciimatc ^^^^ ^^^ noted as being moderate ; yet the sensation of heat was great. The 

relief obtained from the sea-breeze in the day, and from the land-wind down 

the river at night, was very great. The feeling of heat has very little connection with the heat ai 



LOCAL CONDITIONS IN RELATION TO PUBLIC HEALTH. 45 

indicated by the thermometer. In close^ muggy weather, when there is little cutaneous 
evaporation, one feels exceedingly hot and uncomfortable, although according to the ther- 
mometer the temperature is very moderate. This is particularly noticeable at Foochow. With 
the exception of the rainy season, namely May and a portion of June, a sea-breeze as a 
rule sets in about noon; relief is then obtained from the heat and stillness of the forenoon. 
The thermometer, however, does not fall, but rises till about 3 p.m., when it attains its diurnal 
maximum, and the result is not altered by placing the instrument in the wind. The daily range 
of the thermometer is only about 3° Fahr., the minimum being about 8 or 9 o'clock a.m. During 
the night the thermometer alters little, although the comfort obtained from the land-breeze down 
the river at night is great indeed. — (II. 24, 25.) In the Eeport to September, 1872, Dr. Somer- 
ville says of the climate of China that a mummy hand obtained in Egypt decomposed during 
the first rainy season it was in China, although it had withstood a rainy season of ten months in 
Scotland. The circumstance accounts for the absence of any mention of the process of embalm- 
ing being practised in China. — (IV. 56.) 

Of the six months April — September, 1874, it is recorded that although in the hottest 
part of summer the sensation of heat was often excessive during the day, the nights were 
usually tolerably cool and comfortable. The medical officer writes : ' May is the rainy month of 
the season here. We have usually some rain in February, but as a rule the great rainy season 
may be said to commence about the end of April, to last all May, and to go into the first week 
of June. With regard to the nature of the climate at Foochow, from 15th July to 15th 
October, he observes that Sir J. Ranald Martin's description of the rainy season in India applies, 
mutatis mutandis, equally to Foochow at this time. From the 15th July to 15th October, and as 
the rains advance, we live in an atmosphere having all the properties of a vapour bath, and in 
certain states of the wind from the south-east, we experience many of the inconveniences 
ascribed by Hennen to the sirocco of the Mediterranean, which, without affecting the ther- 
mometer or barometer in any remarkable degree, yet inflicts on the delicately sensitive human 
frame a feeling of indescribable languor and oppression, with an exhausting perspiration, much 
like what we suffer from in Bengal during the latter portion of the rainy season. The mind 
seems to partake in the general relaxation, being unfitted for vigorous or sustained effort.' 
About the end of August, northerly and easterly winds generally prevail, and continue more or 
less regularly until the beginning of October, when the north-east monsoon sets in, and the 
hot season is over. — (VIII. 56.) 

In the Eeport from October, 1874, to March, 1875, Dr. Somerville states that the mean actual 
temperature for the whole preceding year, as obtained from actual observations, namely 68'8° 
Fahr., was the exact temperature of the isothermal line that <;uts this district according to the 
deductions on purely theoretical grounds by Dov^. During the half-year, the highest tempera- 
ture in the shade occurred on 3rd October, namely 31'2° Fahr.; the lowest on 16th January, 
namely 38'1° Fahr. ; the highest temperature in the sun on 3rd October, namely, 155'2° Fahr. ; 
the lowest on 13th January, namely 5r4° Fahr. The range in the shade for six months was 
thus, 56-r Fahr. ; for the year, 62-5° Fahi-. ; similarly in the sun, 103-8° Fahr., and 114-8° Fahi-. 
The greatest difference between the dry and wet bulbs took place on 17th November, when 
the former indicated 69-9° Fahr., the latter 55-3° Fahr. ; difference, 14-6° Fahr. The least differ- 
ence on 5th October, when they indicated respectively 75-1° and 74-9°; difference, 2°. The 
range for the six months, 14-6° Fahr.; for the yeai-, 17-3°. From 1st October to 31st March, 
rain fell on 43 days ; the total amount, 9-962 inches. From 1st April preceding to 30th 
September, it fell on 72 days ; total amount, 27-027 inches. Thus for the entire year rain fell 



46 EPITOME OF MEDICAL EEPORTS. 

on 115 days ; the amount 37-589 inches. The months of November and December were dry. During 
the six months ending March, the north-east monsoon prevailed ; diy, bracing, having ' tonic 
properties/ and rendering the cHmate of the locality ' delightful.' — (IX. 1-5-50.) Further : ' It 
is impossible to describe the feeling of exhilaration experienced on the advent of the north-east 
monsoon. The languor and irritability of summer disappear, and are succeeded by a feeling of 
buoyancy and cheerfulness.' — (XI. 39.) 

The general characteristics of the summer half of 1875 were a very high day temperature 
during June, July, and part of August ; a high night temperature, particularly in July ; high 
humidity in April j moderate rainfall throughout the period. — (X. :J2.) According to the Eeport 
to March, 1876, the period of north-east monsoon extends from the end of September or early in 
October to March or the middle of April ; the rainy season from the middle of April to May and 
the first week of June. The south-west monsoon from the beginning of June to the middle of 
September. In the rainy season and south-west monsoon diarrhcea, dysentery, and heat malaise 
are present.- — (XI. 38.) The summer season of 1877 had a general low temperature throughout ; 
cool nights, much humidity, and sudden and great variations. — (XIV. 83.) The Report to March 
says : ' The climate is moist and enervating ; rainfall and thunder-storms scattered over the year, 
but most abundant in spring and early summer. During summer southerly breezes reach the 
settlement from seaward, but there is a great absence of wind-storms. The hot months include 
June till the end of September ; during that time the thermometer in the shade is seldom above 
96° Pahr. or below 70° Fahr. The coldest months are December to the end of February ; ther- 
mometer seldom below 40° Fahr., and with a mean of 53° Fahr. Frost is rare. Sudden and 
great changes of temperature occur at all seasons, but more frequently in spring than in autumn. 
Every year in mid-winter there are some hot days when the thermometer in the shade rises to 
80° Fahr.'— (XXI. 51.) 

In 1871, until the months of August and September, there were few serious cases at all. 
The anchorage, from the physical formation of the country and the presence of a 
sea-breeze throughout the hot season, is in general healthy, and this year has been 
unusually so. — (II. 24.) In the Report for the six months ended 31st March, 1873, Dr. Somer- 
ville attributes much of the health enjoyed at this port to the long cold season ; this gives the 
residents the opportunity of taking - exercise in many forms, and they take full 
advantage of it. He does not, however, recommend strong muscular exercise 
during summer, or anything like over- training at any season; on the contrary, even when cool 
weather sets in, great caution should be observed in passing from the mild exercise appropriate 
to summer to the more severe form of exertion found beneficial in winter. He does not think 
that high training ought to be attempted in China at all. — (V. 43.) From October, 1873, to 
March, 187 !■, the health of the anchorage was good, as also of the Customs staff. The reporter 
observes that as a result of the series of reports now being considered an insurance office has been 
established in China, taking insurance on lives at home rates. He states that for 1872 the death- 
rate in Victoria, Hong Kong, was 3'19 per cent. ; in 1873 it was only r94, or more than a fifth 
below that of London.— (VII. 13.) 

Although the winter climate is grateful to the healthy, the months of September and October 
are trying to the sick, particularly in serious cases of illness occurring late in summer. Chronic 
dysentery assumes a bad form, and remittent fever is more severe during these two months than 
at any other period of the year. According to Dr. Somerville, healthy (foreign) children are 
easily reared here. They are pale, and often fretful in the hot weather, but with the occurrence 
of the north-east monsoon they soon recover colour and activity. The same remark applies, viidatia 



LOCAL CONDITIONS IN RELATION TO PUBLrC HEALTH. 47 

mutmuUs, to ladies. — (IX. 50.) From April to September, 1875, the immunity from serious 
disease enjoyed by the foreign population was assigned to the moderate degree of humidity of 
the air during the period, and to the long bracing winter that follows the advent of the north-east 
monsoon. The physical conformation of the country — hilly, with good natural drainage — has also 
much to do with it. He expresses his belief that the Merchant Shipping Act of 1867 has done 
much towards ameliorating the condition of seamen in matters of health and comfort ; that it has 
reduced the prevalence of scurvy among them by 80 per cent. — (X. 32, 40.) Notwithstanding that 
the summer of 1877 was unusually cool, it was particularly trying to health, not so much in 
regard to fatality by disease as to its prevalence. — (XIY. 83.) 

According to the Report for 1879, the death-rate of foreigners was not higher than that of 
the healthiest district of England. The diseases of ladies and children were ' largely unavoidable, 
because essentially climatic, but the diseases of men were in a great part not so.' The oldest 
male residents are its healthiest, because those for the most part guard sedulously against the 
gun, atmospheric changes, and the temptations of the table. — (XVIII. 65.) According to the 
Report to March, 1881, the natives have not the healthy appearance of those living in the 
mountains, or of those on the sea-coast. Their temperament is more irritable, and, though 
industrious, they have not the push or enterprise of their brethren in the southern part of 
the province. For foreign residents, living in houses in every way suited to the climate, having 
abundance of every variety of good and cheap food, and having every facility for obtaining 
moderate exercise, the climate need not be considered unhealthy. Those of them who observe 
moderation in all things, who avoid violent exercise as much as intemperance in eating and 
drinking, seem to enjoy excellent health. Those who lead inactive lives suffer from nervous 
ailments, and are much more affected by climatic influences than those who choose the middle 
course. The busy season of the year falling in the hot months, by enforcing active and regular 
habits doubtless renders climatic disease among male residents less frequent. The benefit derived 
from active habits may be illustrated in the case of natives, by comparing the active, healthy, 
robust women from the country with the indolent, withered-looking women of the city and suburbs. 
— (XXI. 61, 52.) In the half-year ended March, 1882, as, indeed, for the whole year up to that 
date, the health of the community was exceptionally good. In that Report, Dr. Stewart writes, in 
reference to the health of children at that place : Delicate children of two years of age and under 
have stood forward prominently during the past half-year in health. He does not know anything 
which strikes him more forcibly than the health of very young children now as compared with ten 
years ago and earlier. Then no summer could be got over without a certain quota of them falling 
victims to severe dysentery, varied by infantile cholera. Now, dysenteries occur, but of a com- 
paratively slight character, while the deadly infantile cholera is non-existent. Mothers, too, have 
rebelled against the old dogma of never attempting to bring up a child by hand or bottle, and 
thus far with entire impunity. It seems to him as if he had almost dipped into a new world. 
He has no doubt that there is a wave in disease, and that residents at Foochow are just now on 
the top of the wave. No one can prophesy when or how soon they shall be in the hollow. That 
they shall be some time, and that all the old types and virulences of disease in some degree will 
appear, he does not question. He is of opinion that the greater attention now paid by adults 
to diet has helped to ward off and modify disease. The comparatively pure milk, better pre- 
pared food and tinned milk than used formerly to be had, have done a great deal for children. 
—(XXIII. 35, 36.) 

According to the Report to September, 1871, boils are very prevalent during the hot season, 
and all classes of the community are liable to them. Small-pox is epidemic among the Chinese 



4R EPITOME OF MEDICAL REPORTS. 

in spring, and sometimes also in the winter months; whooping-cough in antumn. Intermittent 
fever is common, although the formation of the land at Foochow is not such as 
accords with the theorj' of causation of that disease. It is not uncommon to find 
a resident on the top of a hill in a paroxysm of ague. DysiDepsia is of everyday occurrence. 
Dysentery is not common among the residents, although often imported. Intestinal worms are 
the greatest pest of children at this port. Among them lumbrici most prevail; among adults, 
tagnia. The greater number of diseases put on the asthenic form. Diarrhoea is very common in 
the hot season; typhoid fever is rare; disease of the liver nearly in all cases imported. 
Rheumatism is common, particularly among seamen. So are enthetic diseases. — (II. 26-30.) 
Cases are by no means uncommon where the liver and spleen are found extensively diseased 
after death, without the presence during life of any other symptoms than those of functional 
disorder. Mixed fevers are rare at this port. — (IV. 60.) During the half-year from October^ 
1872, to March, 1873, the prevailing diseases were unimportant, except those of the heart, 
and typhoid fever. Dr. Somerville is of opinion that the chief mortality takes place by 
dysentery and diseases of the liver ; that the actual death-rate at this port is low, and that 
there is a remarkable freedom from zymotic diseases. Prom April to September, 1874, there 
was an immunity from serious disease. — (V. 38-10.) The diseases which most prevailed were 
diarrhoea, lieat mcdaisv, 'intestinal catarrh,' the latter assigned to the heat and moisture of the 
season. It prevailed chiefly during the hot months, and more especially in May and June. 
It affected equally residents on shore and the shipping population. — (VIII. 02.) 

Although the summer of 1875 was unusually hot, disease was not appreciably increased 
thereby, except in the case of 'intestinal catarrh' and heat mnlaisi'. Dr. Somerville's experi- 
ence tends towards the general conclusion arrived at by other observers, that a high degree of 
temperature alone does not necessarily produce wide-spread disease of a serious nature. He 
describes heat malaise as a protean malady, giddiness being its most common symptom. Next to 
it in frequency are intestinal catarrh, diarrhoea, and dysentery. Most of the cases of diarrhoea 
afloat occur during night in men who sleep on deck, and who doubtless casting off covering, have 
the wind impinge upon the abdomen. As a preventive, flannel rollers are recommended to be 
worn. Dysentery has become less frequent in late years.— (X. 32-43.) In the Report to March, 
1870, a remark occurs as to the unfrecjuency of malarial diseases during the hot season. Zymotic 
diseases have hardly an existence here. Of the deaths that have occurred during the last 
fourteen years the most part have been caused by dysentery, the cases in the majority of 
instances imported.— (XI. 38, 30.) The summer of 1877 was an unhealthy one. Cholera, a few 
sporadic cases of which occur every year, was on this occasion sporadic. Cases of heat malaifie 
were fewer than in the preceding summer. Cases of remittent and intermittent fever were few, 
and all imported. — (XIV, 85.) In 1870, the principal diseases which prevailed were malarial, 
typhoid, and rheumatic, along with proctitis and cholera. Diarrhoea, dysentery, and hepatitis also 
have occurred. The ostensible causes of ague are the surrounding paddy-fi.elds ; of rheumatism, 
the damp and variable atmosphere of the place. Diphtheria, croup, bronchitis, and pneumonia 
occur. Typhus fever used to be rather frequent, especially in one Missionary compound ; but of 
late it has given way to remittent. Next to ague, rheumatism is stated to be the most frequent 
disease. Cholei'a, endemic always, recurs as an epidemic every ten or eleven years. Proctitis 
appears in several instances nearly every summer. The disease is aggravated by the extension 
of the inflammation into the colon. Children are frequently its subjects. The occurrence of 
Foochow ulcer is noticed as taking place in- the hot season. Venereal disease of very virulent 
form prevails. — (XVIII. 05-68.) According to the Report for the year ending March, 1881, the 



LOCAL CONDITIONS IN RELATION TO PUBLIC HEALTH. 49 

list of prevailing diseases inclades malarial fevers and anEemia^ small-pox, measles^ mumps, 
whoopiug-cougli, erysipelas, rheumatism^ cancer, skin and eye aifecfcions, etc. Typhus and 
typhoid fever are endemic. Among Europeans the most frequent diseases are rheumatism, 
diarrhoea, dysentery, bronchial catarrhs, dyspepsia, and lambrici. Among ladies, nervous 
affections are stated to be common. Malarious fever, of more than usually severe type, 
occurred as an epidemic during the three months of September, October, and November, at 
which time the rainfall was slight, and the rice-fields were drying up. Parotitis, small-pox, and 
measles were also epidemic during those months. Annually, during winter, small-pox prevails as 
an epidemic. Syphilis in all degrees of virulence is rife. Cholera has not occurred since 1877. 
' As usual,^ there were numerous cases of lumbrici among children and adults. — (XXI. 52-56.) 

In the Eeport for the half-year ending March, 1882, Dr. Stewart writes as follows in regard 
to the type of disease, as observed by him : ' As it has been remarked in a former Eeport of this 
district, that the distinguishing' type of disease has changed, we can only add to 

. •^. Type of Disease. 

that remark that this year confirms it. It has been said before that ileo-colitis had 
been the distinguishing type, but that it was supplanted by malarial fevers ; that these fevers 
were generally slight and fleeting, though protean in their forms, but sometimes very severe, if 
rarely deadly. This year we have had no genuine case of ileo-colitis, any more than we have had 
during the past five or six years, while remittents and intermitteuts we have had, and without 
marked abatement of their own particular predominance. Two cases of remittent fever assumed 
a very low or typhoid type, while one affected the brain in an extreme manner — the peculiar affec- 
tion being persistent hallucinations, the patient remaining rational, and aware that he was suffer- 
ing from hallucinations. A few doses of hyposulphurous acid procured sleep and allayed the 
hallucinations.' A strong objection to the drug is its pungent smell. — (XXIII. 35.) 

AMOY. 

Amot is the treaty port of the province of Fokien ; the geographical position of the city about 
2-1° 10' 8" N. lat., and 118° 13' 30" E. long. This part of the province just named is very hilly. 
The hills are of granite, but as every tree and shrub has been cut down and the natural grass 
removed, they have a bleak and uninviting look. The granite thus left bare 
absorbs the heat by day, and radiates it rapidly at night. Several large rivers and 
estuaries intersect the country, and thus admit the sea-breezes and monsoons, rendering com- 
paratively mild and salubrious what would otherwise be a hot and unhealthy country. This is 
further increased by the rise and fall of the tide, both of which are great. The places of 
business of Europeans are situated along the foreshore of the town — rather a hot locality — but 
for the most part their private houses are situated on Kulangsu, a rocky ifsland close to Amoy. 
There strong sea-breezes blow during the day, and the land-wind at night. — (II. 10, 11.) 

Every spot of land in the neighbourhood of the city is brought under cultivation. The alluvial 
flats along the banks of the rivers, and gorges among the hills where water is obtain- 
able, are occupied by rice-fields ; in the drier soils sweet potatoes, ground-nuts, ^'"'^ 
sugar-cane, and a variety of other suitable crops are raised.- — (II. 10.) The more general culti- 
vation of the country has diminished the prevalence and intensity of malaria. — (VI. 31.) 

The town of Amoy, in 1871, was described as being ' superlatively dirty. The streets, narrow 
and irregular, are filthy in the extreme, and redolent of every impurity. Pia:s and ^ 

J.J.- £1 J r J o Couserraucy. 

dogs are the sole representatives of the elaborate machinery of sanitation m Euro- 
pean towns, and a scientific sanitarian, with only home-experience to guide him, would confidently 

7 



50 EPITOME OF MEDICAL REPORTS. 

predict tlie reign of epidemics and death. Yet the Chinese manage to live and thrive where he 
would hardly dare to lodge his pigs. There is no typhus, no typhoidj or other disease considered 
the inevitable consequence of defective sanitation, though Amoy is fall of typical fever-dens.' In 
the Eeport by Drs. Midler and Manson it is further added : 'Luckily filth, overcrowding, and bad 
food, are not the only factors necessary for the manufacture of a typhus epidemic— were they so, 
we should live in Amoy in perpetual dread.'' — (II. 11.) 

The people of Amoy, though industrious, are poor in the extreme, and their earnings small : 
60 to 100 cash per day for an ordinary labourer, 120 to 150 cash for a mechanic. Eice, or a 
mixture of rice and sweet potatoes, flavoured with pickled vegetables, or salt-fish, 
" ' '' is the staple food ; pork and beef the luxuries of the few. In the inland districts 
the people are chiefly agricultural; along the coast, seafaring. — (II. 10.) The diet of a well- 
to-do Chinaman is sufflciently nutritious. Eice, or other farinaceous food, 
animal food of various sorts, oils, fresh and salted vegetables, supply in abundance 
all the elements for healthy nutrition. But a large proportion of the labouring classes, and 
professed vegetarians — no small body — live exclusively on rice, fresh and salted vegetables, and 
a small allowance of salt-fish. Still lower in the scale are great numbers to whom rice even is a 
great luxury, and whose diet consists of little more than sweet potatoes and salted vegetables, 
without any animal admixture whatever. Sometimes their poverty is so extreme, that fresh 
sweet potatoes are beyond their means, and they are obliged to confine themselves to the dried root 
so called, the very cheapest food, and in times of scarcity imported in large quantities. Some of 
the people are so poor as not to be able to buy firewood enough to cook, and are obliged to content 
themselves with softening the same dried potato with a little water, seasoning it, if at all, with salt 
borrowed from some charitable neighbour. Among such classes as these, anaemia from insufficient 
food is common. In the same Eeport, the medical ofiicer discusses the subject of Bccce. 
He writes : ' The principal directing influences in the development of characters of a 
race are climate, physical characters of countr}', food, and the diseases that destroy or impair it. 
The two latter in their turn depend upon the physical characters of a country.' In the province of 
Fukien an animal diet is not obtainable; the inhabitants accordingly adapt themselves to a diet of 
sweetpotatoes, or other farinaceous substances, a circumstance which, the reporter observes, indicates 
the 'adaptability of man, along with some of the other animals, to effect changes from omnivorous 
to herbivorous, to survive the process, and even develop into a vigorous race.' He considers, 
however, that before this is done, 'a long and unintermitting process of selection and rejection has 
been gone through. The influence of endemic disease is referred by the writer chiefly to the 
question of malaria, as leading to propagation of sickly children, and to inherited susceptibilities. 
He alludes to the exemption of African races from fevers, and the same pecu.liarities in Chinese, 
Malays, and Hindoos, though in a less degree. He observes that in India and China improved 
cultivation and the consequent decrease of malaria has led to the population of both countries being 
' slightly susceptible, though not so much so as the exotic European not used to resist such 
influences.' Certain diseases, when attacking races for the first time, are characterized by an 
especial degree of virulence and of deadliness. Syphilis and small-pox are examples in point. 
But while there is a natural tendency to improved constitutions and disease-resisting qualities, the 
acquisition of a high degree of civilization, humanity, and science tend to the fostering and 
propagation of forms less able to resist disease on account of the conditions thus induced 
fostering the weak and susceptible. This, he observes, is a drawback to civilization. The 
reporter says : '' It is a common observation with some, when discussing the unhealthiness of 
these climates, that wc should find thero as healthy as our native lauds did we assimilate our 



LOCAL CONDITIONS IN RELATION TO PUBLIC HEALTH. 51 

habits to those of the natives. But generations have passed before the natives' suitability to 
the climate^ diet, etc., has been acquired^ and millions must have died in the process of adapta- 
tion.'— (VI. 28-31.) 

The rainfall is capricious. For the most part the climate is dry^ frequently several years pass- 
ing without a sufficiency of rain. Famine, or great distress, is the consequence, and epidemic 
disease in some form follows in their train. From April to September, 1871, after 
three years of drought, plentiful rain fell ; tanks and wells that had been useless or 
offensive for a long time were refilled. During the six months the mean maximum temperature 
registered was 91° in July ; in the others it ranged between 82° in April, and 89° in May and 
September. The highest mean minimum, 78°, occurred in August; the lowest, 60°, in April. 
During the winter and spring months the climate is much cooler. Then the clear, cool air goes 
far to reinvigorate after the summer heat; outdoor exercise also is possible. — (II. 10.) Accord- 
ing to the report to March, 1872, the preceding winter, like the summer before it, was the coldest 
that had occurred for many years, ice having been seen on three or four moruings in the middle of 
December. Generally speaking, the winter climate of this settlement would compare favourably 
with that of the most popular health-resorts on the Mediterranean. It is added, however, that the 
prevailing high winds and the sudden outbursts of north-easters are objections against it. The cold 
is never unpleasantly felt, yet it is sufficient to admit of exercise being taken. — (III. 22.) In the six 
months ending March, 1873, the weather was unusually dry and mild ; the rice-crop consequently 
scanty — in many districts a complete failure. — (V. 7.) The half-year ending 30th September, 
1874, was characterized by high temperature, and, especially during the first three months, by 
heavy rainfall and damp, muggy weather. — (VIII, 67.) According to a record of meteorological 
observations given for the year from 1st October, 1874, to 30th September, 1875, the following 
represent the mean monthly maxima and minima for that period, namely : the highest for the 
twelve months, 95° in August j the lowest maximum, 70° in the months of January and February; 
the highest minimum, 79° in August ; the lowest, 40° in January. The temperature of the 
summer and autumn months was higher than the average of former years. With this higher 
temperature, the absence of thunder and rain during the afternoons and evenings was noted. — 
(X. 20.) In the half-year ending 30fch September, 1876, the highest day temperature recorded, 
viz., 93'^ F., occurred at noon on the 9th September; the highest night temperature, viz., 86° F., 
at midnight, on 28fch July. The mean temperature of the six months was lower than usual. — 
(XII. 36.) 

In the Report for the six months ending 30th September, 1871, the circumstance is noticed 
that neither typhus nor typhoid fever occur in the town of Amoy. With the exception of small- 
pox there occurs no representative of the class of continued fevers which claims so large a number 
of victims in Europe. Drs. Muller and Manson had never met with a case of scarlet fever, measles, 
or relapsing fever there. Diphtheria did not exist, or was very rare ; mumps and 
whooping-cough are common enough. For Europeans, well housed, temperate, 
and who use discretion in exposing themselves to the sun and rain, the climate of Amoy is not 
considered unhealthy. A little languor by the end of summer, becoming more pronounced the 
longer one stays here, is ' perhaps the only climatic disease a sensible man need suffer from.'' The 
abundant rain of the present season had a beneiicial effect on health, both of the population on 
shore, numbering about 150, and that afloat, estimated at 1,927. — (II. 11.) In the half-year ending 
31st March, 1872, the health was rather above the average. — (III. 22.) In the summer half of 
that year, except for the occurrence of dengue fever, the public health was good. — (IV. 7.) In 
the summer half of 1873, the health alike of natives and foreigners was unusually good. 

7—2 



52 EPITOilE OF MEDICAL REPORTS. 

In reference to tlie means for preserving health, Dr. Manson writes : ' We should endeavour to 
make the chmate suit us, not us the chmate. We ought to remember that we are exotics here, 
and that we should surely sicken and die if we did not, in one way or another, try to reproduce 
the circumstances of the lands in which our constitutions were bred. The advice that tells us to 
eat rice and practise all sorts of self-denial should, if it followed up the principle it is founded on, 
tell us to eschew sun-hats and umbrellas, and to expose our shaved heads and naked bodies to the 
hardening and acclimatizing rays of the mid-day sun, live in stuffy hovels, exclude ventilation, and 
sleep on the ground-floor. The true advice is to make China as Uke Europe as we can, and by 
cultivating temperance, remain vigorous to resist malign influences when they come.' — (VI. 20, 32.) 
The winter of 1870-74 was healthy, both as regards the native and the foreign population. — 
(VII. 26.) The winter of 1875-70 also, was very healthy ; yet a good deal of choleraic diarrhoea pre- 
vailed among the natives. The Customs staff was less fortunate than usual in regard to health. 
— (XI. 30.) Although from April to September, 1876, no epidemic prevailed, the mortality is 
stated to have been unusually large. — (XII. 30.) In the half-year ending March, 1878, the health 
of the community was good ; cholera, which had prevailed in the preceding similar period, had 
disappeared. — (XV. 25.) To September of that year, the health of the port was ' unusually good.' 
No death occurred among the residents. — (XVI. 12.) Similarly, in the six months ending 31st 
March, 1880, the health of the foreign community was 'unusually good/ very few cases of 
serious illness occurred, and only one death, namely, by abscess of the liver. — (XIX, 30.) Prom 
23rd November, 1879, till 20th July, 1880, there was no death in the foreign community; from 
the latter date till the end of September, there have been seven deaths. With the exception of 
an epidemic of fever, the general health, as far as climatic disease of local origin is concerned, has 
been fairly good. — (XX. 1.) During the half-year to 31st March, 1881, the general health excel- 
lent. — (XXI. 57.) In that to 30th September of the same year, good ; no epidemic among natives 
or foreigners. — (XXII. 1.) 

According to the Report for the half-year ending 30th September, 1871, so great is the pre- 
valence of small-pox at Amoy, that every one of the population who is unprotected by vaccination, 
should he live long enough, is sure to contract the disease. Next in fatality are 
malarial diseases, including remittent fever, ague, diseases of the spleen and liver, 
anaemia, and their consequences ; cholera next, and then perhaps lepi'osy. Phthisis, bronchitis, 
pneumonia, cancer, etc., are also rife. At the commencement of the rains, catarrh and diarrhoea 
attacked many of the European children. Several cases of inflammation of the auditory canal 
occurred, and from its frequency might almost be looked upon as epidemic. Among the shipping 
population climatic diseases have been fewer than in any of the past sis years, a fact due to the 
coolness of the present summer. — (II. 11.) Malarial diseases, although they occurred during the 
half-year ending March, 1872, were much less frequent than in summer. Disease of the respira- 
tory organs is rare. A few mild cases of catarrh occurred among the European children. A trivial 
epidemic of mumps prevailed in January and February, affecting both foreigners and Chinese. A 
fatal case of typhoid fever occurred on board a French brig, arrived from Yokohama and Ohefoo. 
Elephantiasis is often met with in the Chinese; ague, or other malarial disease, its usual accompani- 
ment. — (III. 22,24.) In the summer of 1872, a severe epidemic of dengue occurred. Among the 
floating population, intermittent fever, enthetic diseases, and diarrhcea were the most prevalent dis- 
orders. — (IV. 7.) In the succeeding cold season the sequelee of dengue presented themselves, chiefly 
as rheumatism, debility, dyspepsia, and paralysis of particular groups of muscles. In the Report 
to March, 1873, it is stated that scarcely had dengue subsided, than ' an epidemic of syphilis 
began.' Famine threatened in consequence of the failure of rice-crops from insufficient rainfall. 



LOCAL CONDITIONS IN EELATION TO PUBLIC HEALTH. 53 

The scarcity was made up by supplies obtained from Japan, and the completion of telegraphic 
lines was looked upon as rendering the recurrence of dearths in famines for the future impossible. 
During the winter a few cases of whooping-cough occurred among the ChinesOj and since the month 
of January small-pox was rife. — (V. 7, 8.) In the six months ending September of that year, a 
limited epidemic of dysentery occurred during August and September. Plentiful rainfall took 
place, and the crops wei'e abundant. The ' epidemic ' of syphilis, above noticed, had now subsided. 
In consequence of the prevalence of cholera in India and the Straits Settlements, quarantine was 
for a short time established. Malarial anaemia was noticed as a prevalent condition. Of agues, it is 
statedthat ' many come and go without leaving any permanent bad effects.'' — (VI. 20, 22.) In the 
six months ending 31st March, 1874, no death occurred among the resident foreign population on 
shore. Among those afloat five deaths occurred, their causes abscess of the liver and dysentery, 
angina pectoris, aneurism, of the aorta, and accidental drowning. — (VII. 26.) In the early 
part of the hot season of 1874, diarrhoea prevailed to a greater extent than it usually does at that 
period of the year. In nearly all cases the liver was affected. Fever, particularly of the remit- 
tent type, was present. No epidemic prevailed. — (VIII. 67.) In the half-year to September, 
1875, there was more than the usual amount of abdominal complaints, as choleraic diarrhoea, 
dysentery, etc. These chiefly prevailed in August and September. — (X. 26.) Among the Chinese 
choleraic diarrhoea increased in severity towards the end of September and in October. In the 
latter month ' many hundreds ' of them died. With the cold weather of November, the disease 
diminished, and by December had disappeared. — (XI. 30.) In the six months ending 30th Sep- 
tember, 1876, no epidemic prevailed among natives or foreigners, thus contrasting with the 
corresponding months of last year, ' when a disease closely resembling cholera was prevalent and 
fatal among the Chinese.' The number of deaths among the foreign community was unusually 
large, but from general rather than particular diseases. Aneurism is rare among the Chinese ; 
so are pyemia, erysipelas, and allied diseases, notwithstanding the overcrowding, the great 
number of open suppurating wounds, and the imperfect sanitary conditions in the native hospital. 
(XII. 36, 39.) In the Report for the half-year to March, 1877, Dr. Manson enters at length upon 
the subject of hsematozoa. — (XIII. 1 3.) In the similar period ending 30th September, 1877, there 
was an unusually high rate of mortality, it being accounted for by the occurrence of an epidemic 
of cholera. The first case of the disease took place in June. The statement occurs that in 1858-64 
chronic diarrhoea and fevers were very prevalent among foreigners living at Amoy. Then the 
majority lived in the Chinese town, and those who lived at Kulangsu were exposed to the risks 
of living in the neighbourhood of ground that had once been cultivated, but had been allowed to 
become waste. Now almost every patch of ground is cultivated, foreigners live in good houses, 
attention is paid to the water-supply, whence the disappearance of these diseases. But the Chinese 
population is rapidly increasing, and thus a new danger to health is arising from this source. — 
(XIV. 27, 33.) In the six-monthly period ending March, 1878, cholera had disappeared^ and 
' small-pox, usually so prevalent in spring, was scarcely present.' — (XV. 25.) In the year end- 
ing 31st September, 1879, nine foreigners died at Amoy. A fatal case of diphtheria, recorded 
among the deaths, was stated by Dr. Manson to be the first of that disease he had seen in China. 
It is reported to occur among the Chinese, although rarely. Typhoid fever of local origin was 
met with for the first time in Amoy : it occurred last winter, when a circumscribed epidemic of 
the disease prevailed in Kulangsu. During the months of March and April a peculiar form of 
fever prevailed among children. An unusually extensive epidemic of small-pox occurred during 
the previous winter, and, as observed, the annual recurrence of the disease at the corresponding 
period of the year is regularly looked for. Daring summer and autumn the Chinese sufferen to a 



54 EPITOME OF MEDICAL IlEPORTd. 

less extent than usual from fevers; 'as usual' several cases of diarrhcBa occurred among cliildren,bufc 
no suspicion of cholera. — (XVIII. 58.) According to the Report to 31 st March, 1881, the spring 
small-pox epidemic was not particularly violent or widespread among the natives, and only one 
foreigner was attacked. In February andMarch extensive pneumonia followed measles in the Chinese. 
Although measles was epidemic in the native town at the end of the period, foreign children had 
hitherto escaped. — (XXI. 57.) In the six months ended 31st March, 1882, a severe and often 
fatal form of remittent fever prevailed within certain limited districts during autumn. The popu- 
lation as a whole was not implicated, and the disease did not attack any foreigners. — (XXIII. 17.) 



TAMSUI AND KELUNG. 

Tamsui is situated on the N.W. of the island of Formosa, the houses being built on the right bank 
of the Tamsui river. During the tea season, which comprises all the hot months, the merchants 
reside for the most part at Twatutia, a settlement about twelve miles up the river, 
where the tea is brought for sale. Kelung, the Coal port, on the N.E. side of the 
island, and about thirty miles from Tamsui, forms also a small foreign settlement where the 
officers of the Customs staff live. — (A"II. 23.) In the neighbourhood swampy paddy-fields and 
vegetable-gardens exist, both watered with human manure. — (XI. 21.) The mining locality 
at Coal Harbour is surrounded by almost entirely uncultivated hills covered with a sparse jungle 
—(XIV. 82.) 

During the year ending September, 187G, the rainfall was recorded as having been very con- 
siderable. There was an increase of oj wet days as compared to the preceding year, rain having 
fallen on 147 days in the entire year. — (XII. 1.) In the six months ending Septem- 
ber, 1877, the heat was not excessive ; the rainfall -Jo 93 inches, the number of wet 
days, 52.— (XIV. 82.) In the year ended 30th September, 1878, rain fell on 118 days. The 
summer was hot and long. — (XVI. 18.) In that to September, 1870, rain fell on 116 days. The 
summer was prolonged, but not excessively hot. — (XVIII. 64.) 

In 1874 the foreign community averaged only eighteen in number. The general health was 
excellent. One or two slight cases of intermittent fever occurred during the summer of 1873 ; 
Health. but they yielded readily to quinine. One case was tedious, from the circumstance. 
Diseases. the medical officer thinks, that the patient had to submit to a constant repetition 
of similar food in the hot weather ; such as fish and pork, and the difficulty which exists in 
obtaining delicacies, there being no sheep here, and the beef, when obtainable, being coarse and 
tasteless. A dispensary for the Chinese was started by Dr. Ringer and the Rev. G. L. Mackay. 
Several patients suffering from leprosy applied for treatment. — (VII. 23.) Daring the heat of 
the summer season of 1875 some cases of severe diarrhoea, with vomiting and febrile disturbance, 
occurred ; but no cholera. In Peking one or two cases of ague occurred. Among the Chinese 
treated at the dispensary, the most prevalent affections comprised those of the eyes, alimentary 
canal, respiratory organs, and skin ; next to these were debility, venereal diseases, rheumatism, 
and ulcers. — (XL 21.) In the year to 30th September, 187G, intermittent fever and a 'low febrile 
indisposition,' which prevailed among the foreign community, were assigned to the unusual amount 
of rain that had fallen. Several cases of severe diarrhoea, with much pain and vomiting, occurred. 
They were treated for the most part with opium, morphia, chloroform, and hydrocyanic acid ; 
quinine was subsequently given, with much benefit, — (XII. 1.) Daring the winter months of 
1870-77, the health of the foreign residents was remarkably good. One or two cases of inter- 



LOCAL CONDITIONS IN RELATION TO PUBLIC HEALTH. 55 

mittent fever were notedj and those rapidly yielded to quinine; one case of small-pox occurred. — 
(XIII. 7.) 

In tlie half-year ended 30th September, 1877, the health of the foreign community of North 
Formosa compared somewhat unfavourably with that of the winter months. A considerable 
number of cases of malarial fever occurred, chiefly of the remittent and intermittent types. At 
Coal Harbour, all the mining experts were thus attacked, although during the previous year, 
it being the first of their residence, they were not so attacked. In the middle of February, 
1,500 Chinese troops were landed in Kelung ; at the end of September, 300 of them had 
succumbed to various diseases, chiefly a low form of fever. Cholera did not appear, notwith- 
standing the severity with which it raged in some parts of China. It is observed that abject 
poverty, so often seen in the large cities of the mainland, is scarcely ever observed on this island. 
■ — (XIY. 82.) In the year to 30bh September, 1878, there was an unusually large number of 
cases of sickness among the foreign community, malarial fever ranking high in the list. Dr. 
Einger notices that some cases of this form of fever were followed by boils. He records a death 
by puerperal fever. — (XVI. 18.) In the summer of 1879 there was, as usual, a considerable amount 
of malarious fever ; almost all the residents having suffei'ed more or less from the intermittent 
or remittent form. — (XVIII. 64.) Four deaths occurred. In the year to September, 1880, the 
health of the foreign community was comparatively good. During summer, malarial fevers, as 
usual, were somewhat troublesome, but in most cases not very severe. — (XX. 16.) 



TAKOW AND TAIWAN-FOG (ANPING). 

The Port of Takow is situated on the west coast of the island of Formosa, in latitude 22° 36' 
14" N., and longitude 120° 16' E. It lies close to the sea. The land in the neighbourhood is, with 
the exception of Ape's Hill to the north, flat and richly cultivated, forming a large 
plain, extending inland about 20 miles. Beyond this are the mountains forming joart 
of the great central ridge of the island. Taiwan-foo lies about 2-5 miles north from Takow. 
During the south-west monsoon the majority of the foreigners in South Formosa reside in Takow. 
— (II. 67.) The settlement is divided by an intervening lagoon, the seaward and south boundary 
of which is formed by a long low sand-spit. Some of the houses built on this locality do not 
enjoy the immunity from malarial diseases which is possessed by those erected on the other side 
of that lagoon. This is accounted for (1881) by the proximity of dense vegetation, and by the 
fact that the whole spit is one enormous gi^aveyard, in which bodies are interred with but scant 
regard to ordinary hygienic requirements. — (XXI. 58.) 

In recent years, few foreigners outside of the missionary community reside in the city of Taiwan- 
foo itself, their houses, godowns, etc., being situated at the village of Anping. This place is 
sepai'ated from Taiwan-foo by a low-lying plain, from which, since the time of the Dutch occupa- 
tion, the sea has in great part receded. Anping is about a mile from the coast, on the bank of a 
creek that in one direction runs up to Taiwan-foo, and in another, communicates with a stream. 
At the mouth of this creek lies the celebrated Anping bar, to cross which it is necessary to get 
into tubs placed on bamboo catamarans. The plain itself at high water, especially in the neigh- 
bourhood of Anping, is in several places submerged, and, becoming uncovered at sanitation 
extreme ebb, exposes large tracts during certain portions of the day to the rays 
of the sun. From a sanitary point of view, permanent residence either at Taiwan-foo or Anping 



56 EPITOME OF MICDICAL EEPORTS. 

is not likely to be free from objections. Foreigners have raised the ground on which their dwelling- 
houses are built. — (XXIII. 27.) There is a supply of good water within easy access 
^'""'- of the settlement.— (II. G7.) 

In the six months, April to September, 1871, the maximum temperature recorded ranged 
from 81'° Fahr. in the first-named month to 89° in June, thence descending to 87° in September j 
the lowest from 70° in April to 80° in June, thence ranging between that point 
and 78° Fahr. to September inclusive. Eain fell on 60 days. The fall took place 
chiefly in heavy thunder-showers in the afternoons of every second or third day from May 
to September. — (II. 67.) For the half-year ending March, 1872, the temperature was described 
as low, and not subject to great variations; the insular position of Formosa admitting of its sea- 
ports having a climate which is ''one of the best in China.' The highest summer temperature 
during 1871 was 87° Fahr. ; the lowest winter temperature 50' Fahr., giving a range of o9° Fahr. 
The range between day and night is small. The climate of this place is accordingly at times 
taken advantage of by Chinese suffering from phthisis, who resort to it from the mainland. The 
highest temperature attained during the period from October, 1871, to March, 1872, was 88° Fahr. 
in October; the lowest maximum, 74° in February. The actual lowest, 55° in March; the 
maximum of the monthly lowest, 77° in October. Eain fell on 27 days, but only in very 
slight showers. — (III. 34.) During the six months ending with September of the same year 
there occurred an unusually heavy rainfall, with an absence of high winds; yet prior to the 10th 
of May there had been scarcely any rain whatever for nine months. On that date heavy rain fell, 
and continued for three days ; afterwards the rainfall was almost nil. — (IV. 24.) Through- 
out the whole year ending March, 1873, the rainfall was unusually small. — (V. 26.) During the 
six months ending September of that year, the rainfall was exceedingly large, the temperature 
somewhat lower than usual. — (VI. 38.) In the six months ending September, 1874, the rainfall 
was even greater than in the corresponding period just noticed. According to the testimony of 
the Chinese themselves, the quantity of rain was greater than it had been for forty years. 
The temperature, as indicated by the thermometer, presented little change from the year 
preceding. Scarcely a day of the six months passed without a cool breeze which lasted the 
greater part of the day. The thermometrical observations gave a very inaccui'ate idea of the tem- 
perature as judged by bodily sensations. — (VIII. 12.) As a rule no rain falls during the winter 
season; but during the six-mouthly period ending- March 1876, rain fell on several days in each 
month. — (XT. 24.) During the yearly period ending 3ist March, 1878, the actual monthly maxi- 
mum temperature, namely, 92 ' Fahr., was registered in September — the lowest maximum, 83° Fahr., 
in February ; the highest minimum, 74° Fahr., in ilay, and again in October — the actual minimum, 
53° Fahr., in January. According to a table given, rain fell on 17 days only throughout the year, 
of which 10 were in July and August ; the total fall 41'18 inches for these months, out of a total 
for the year of ri5'14. This rainfall, though considerable, was for the most part absorbed by the 
parched ground, and did not produce the agents usually supposed to give rise to jDaroxysmal 
fevers. The summer six months were charactei'ized by the absence of the usual severe rain and 
wind storms. The prevailing winds were from the west and north-west. The winter was un- 
usually warm, for a month seldom passed without several days of mist and relaxing southerly 
winds. — (XV. 30-37.) Daring the two years ending 31st March, 1881, the climate is described 
as being good, considering the geographical position ; the drawbacks consequent on heat by no 
means so great as one would expect. Here the sea-breeze has access, hence a degree of salubrity 
exists which is not found at Taiwan-foo, situated about 30 miles farther north. Dr. Myers alludes 
to the very favourable effect the climate of South Formosa appears to exert in cases of tubercu- 



LOCAL CONDITIONS IN RELATION TO PUBLIC HEALTH. 57 

losis. It would seem as though arrest of the disease may often be brought about by this means ; 
and a case is noticed in illustration, but in which the disease returned and was fatal soon after the 
patient arrived back in England.— (XXI. 58, 59.) In the Eeport, to March^ 1882 he reverts to 
this subject. He is ' constrained by further experience once more to call attention to the 
peculiarly good effects apparently produced in tubercular disease by residence in Takow.'' He 
considers that in part this arises from the presence in the atmosphere of sulphurous acid dis- 
charged from springs in the vicinity of the settlement. — (XXIII. 18.) 

According to the same Report, namely, that for the half-year ending March, 1882, the climate 
can hardly be described as a very desirable one. The prevailing disease is fever. Unless a man 
was of a perfectly strong and healthy constitution, he would run no little risk, were circumstances 
to necessitate his remaining long in Takow. Taking the last two years' records, the mean 
temperature at Takow is for the whole year about 76° Fahr., or for the seven cool months about 
72° Fahr., and for the five hot months 831° Fahr. In the summer this is described as being 
almost the coolest place in China, the mercury rarely touching 90° Fahr., and a fresh breeze 
generally blowing. — (XXIII. 28.) 

In 1871, the foreign residents in Taiwan-foo numbered only 30. The general health of that 
community was good. The only climatic diseases recorded were mild cases of remittent and 
intermittent fever. In one of the former, change of climate was necessary; in Health and 
one of the latter the attack was due to travelling through a malarious district. In Diseases, 
that the fever quickly yielded to quinine, but was followed by very acute neuralgia of the supra- 
orbital nerve, recurring once and sometimes twice daily, and continuing on each occasion for half 
an hour to an hour. Quinine in large doses failed to check the recurrence of the paroxysms, and 
the hypodermic injection of morphia had no permanent effect. Arsenic ultimately succeeded in 
bringing about a cessation of the neuralgic attacks. One case of urinary calculus occurred in a 
subject who had been about two years in the island ; the concretion was voided by the urethra. 
There were no deaths. Among the natives syphilis is rife. The people are described as being 
grateful for treatment at the dispensaries established for their benefit. Leprosy is known to 
prevail among them, but no lepers applied for treatment. Diseases of the eyes are very numerous, 
being due to the frequent showers of very fine sand which occur during the N.E. monsoon, the 
sand being brought by means of the wind from the country lying to the north. Malarial fevers 
were common, quotidian being the most ordinary type. In many cases there was also congestion 
of the spleen. In the cases of remittent fever, there occurred great and sudden prostration, low 
delirium, and oozing of blood from the fauces. Enlarged spleen is common, associated with 
anaemia or ulcers of the legs, more frequently of the left leg than the right. These cases improve 
under the continued use of iron. Phthisis is common in the district. Goitre prevails among the 
inhabitants of the lower ranges of hills at the foot of the mountains. Heart disease is rare. 
Fibrous tumours of the neck are not uncommon. — (II. 67, 68.) In the half-year ending March, 
1872, the health of the residents on shore and of the ship population was excellent. Throughout 
the entire previous year the only diseases observed were a few cases of ague, and two cases of 
remittent fever. Dr. Manson accordingly combats the proposal made to remove the British 
Consulate from that settlement on account of the unhealthiness of the locality. Throughout the 
whole previous year the principal causes of death among the native population were malarial 
fevers. These were most prevalent during the months from August to November, both included, 
and least during February and March. Most of these cases came from the flat country in the 
neighbourhood of Takow, but a considerable number of patients suffering from intermittent and 
remittent fevers, and spleen-enlargement also came from Lambay, a small rocky island about 10 



58 EPITOME OF MEDICAL REPORTS. 

miles south from Takow, and separated from the mainland of Formosa by about 6 miles of sea. 
Judging from its physical characters Lambay Island ought to be the reverse of what is usually 
considered malarious, but malarious fevers are exceedingly prevalent there. (III. o-i-bo.) 

For nine months prior to the 10th of May, 1872, there had been scarcely any rain. ^ A great 
dearth of grain existed in consequence, and a large number of the inhabitants were m a state 
of destitution. Coincident with a heavy rainfall on that date a severe outbreak of intermittent 
and remittent fevers took place, and told heavily on the Chinese population, reduced by famme. 
Among the foreign residents, a few cases of intermittent fever, two of whooping-cough, and one 
of mild dysentery occurred. Among the shipping, two cases of intermittent fever and five of 
diarrhoea. Enthetic and parasitic diseases were frequent among the natives ; the latter mcluding 
lumbrici, scabies, and ringworm. Malarial fever became epidemic towards the end of May, and 
so continued throughout the summer. A similar form of disease prevailed also at Pitau, a large 
town situated about 6 miles inland from Takow, as also in the surrounding country. No sequels of 
malarial fever, dysentery, and enlargement of the spleen were observed. — (IV. 21, 26.) Durmg the 
half-year ending 31st March, 1873, the health of the foreign community was good. Malarial disease 
was absent, both among the residents and seafaring population. Among the native Chinese the 
amount of sickness was much below what it had been in the summer half-year ; this attributable 
to the fact that malarial disease is less prevalent in winter than in summer. Dengue fever, 
prevalent at Amoy during the autumn of 1872, made its first appearance on Formosa at 
Taiwan-foo, and within a few weeks had attacked almost the entire population of that city. 
The disease was believed to have been imported by means of the Mary. Amongst seamen 
an unusual amount of syphilitic disease prevailed. Malarial fever was stated to prevail to the 
greatest extent in June, July, August, September, and October, especially so in June and July, 
when the fever assumed more of the remittent and adynamic type, with a tendency to dysentery 
during convalescence. Small-pox was very prevalent both among the natives along the coast-line, 
and among the aborigines in the interior of the island. A large number of cases of phthisis were 
treated.— (V. 26.) According to the Report for the six months ending September, 1873, excellent 
health prevailed among the foreign community generally. Malarial diseases, including fevers 
and dysentery, were the most common affections. Among the natives the principal causes 
of death were small-pox and malarial fevers.— (VI. 38.) During the six mouths ending 
with September, 1871, the health of the community was very good, only three cases being 
referable to climatic causes. The Europeans had for some time been in the habit of bathing m 
the morning in an adjoining lagoon, a prolongation of the harbour, where the temperature at 
ebb tide is about 88° Fahr. Immediately after the bath followed a douche of water at a very 
low temperature, and in some instances attacks of fibricula resulted. At Taiwan-foo the 
ordinary European residents enjoyed good health, but several of those who lately arrived 
to instruct the Chinese soldiers in mihtary drill suffered severely from fever. Among the Chinese 
periodic fevers were very prevalent, especially towards the end of the season j yet it was stated 
that Chinese troops encamped about 6 miles inland on the island (Formosa) enjoyed excellent 
health.— (VIII. 12.) 

From October, 187o, to March, 1876, the health of the foreign community was not so good as 
it had been in previous winters. Several cases of intermittent fever occurred among residents 
in a locality which has the reputation of being malarious and unhealthy. In October, when the 
country was drying up after the rains, malarious fever assumed an epidemic form, and was more 
fatal than it had been for many years. Towards the end of that month, an epidemic of simple 
cholera occurred among the natives, of whom considerable numbers of the weakly died. Small- 



LOCAL CONDITIONS IN RELATION TO PUBLIC HEALTH. 59 

pox also prevailed. — (XI. 24.) That disease is neyer absent from Formosa. Throughout the 
entire year ending March, 1877, the health of the foreign community was better than usual. 
Towards the end of summer there were three cases of simple intermittent fever, and in the winter 
six months only one case of climatic disease among them. Among the shipping, the amount of 
disease was much as usual.— (XIII. 39.) The year to 31st March, 1878, was unusually healthy ; 
only a few cases of malarial fever among the foreign residents. Natives as well as foreigners 
suffered from these diseases; among the former, chiefly those arrived from uncultivated districts in 
the interior of the island. Both among native Chinese and foreigners, the type of disease was 
milder than usual. Some cases of the prevailing remittent fever were ' pernicious ' iu type, 
some were associated with rheumatism. Among the floating population there were many cases 
of diarrhcEaj and on board ships from Hong Kong and Amoy venereal complaints were common. 
A case is recorded of a foreign resident arriving from the south suffering from tubercular cavities 
in one lung. Temporary benefit was derived from the change of climate, but subsequently he 
died from pulmonary apoplexy. In spring, small-pox made its appearance among the natives. 
Asiatic cholera, which visited several ports on the mainland, never appeared either in Takow or 
Taiwan-foo; nor did Dr. Eennie obtain evidence of a case of that disease having appeared in South 
Formosa, notwithstanding that during the time of its epidemic prevalence at Amoy, several 
vessels from that port arrived at both these places. — (XY. 36.) In the two years ending 31st 
March, 1881, the health has been good, the diseases peculiar to the place few as far as foreigners 
are concerned. The greatest inconvenience experienced by the residents is the want of good 
food, the commissariat having little beyond fowl, fish, and intermitting supplies of inferior beef. 
Attacks of ague are rare, save in those who reside in the two most southern dwellings on the 
spit. The chief factor of discontent is the sense of isolation from the rest of the world. In 
reference to the subject of a hospital recently established at Takow, Dr. Myers writes that ' there 
are few places where the entente between foreigners and the Chinese is more declared than in 
Formosa. Even the uncivilized aborigines are not above seeking aid, and only the other day wo 
had quite a crowd of these " savages " who had obtained passports for the purpose of testing the 
powers of Western medical skill. During the past ten years, upwards of 20,000 patients have 
been treated.' A remark occurs in a previous page of the Eeport now being considered, which is 
important in relation to the question of phthisis in man — namely, that in South Formosa monkeys 
in a state of captivity are peculiarly liable to pulmonary diseases. — (XXI. 58-60.) 

During the year ending March, 1882, the health of the community was, on the whole, very 
good. Of the diseases which mostly prevailed, the most prominent was fever, evidently of malarial 
origin, yet special and peculiar in many of its characteristics. Dr. Myers observes, that ' as far 
as the mercantile community is concerned, the habit of making Takow headquarters, and resorting 
thither as soon as work in Anping is concluded, does much to obviate evil consequences ; and in 
case of actual attack, health is soon recruited by a prolonged stay there. With reference to the 
permanent residents, a short stay is sufficient to produce in them such ailments as one would 
expect from the nature of the local conditions. During the months of December, January, and 
February, the climatic conditions are very much improved. — (XXIII. 18-28.) 



8—2 



GO EPITOME OF MEDICAL REPORTS. 



SWATOW. 

The geographical position of Swatow is latitude 28° 23' N., longitude 116° 42' E. The city 
is situated on the left bank of the river Han, 5 miles from its mouth, and at a distance of 
220 miles E.N.B. from Canton. The material of all buildings is a sort of concrete, 
made from disintegrated felspar rock, mixed with lime from calcined oyster-shells. 
The walls are carried up entire, and openings are then cut for doors, windows, and spaces for 
beams and rafters. The beach is suitable for sea-bathing. These particulars are obtained 
from Keith Johnston's ' Dictionary of Geography, 1877.' They are introduced here in view 
to uniformity in the nature of information given in the present resume of Eeports. 

In the Eeport for the half-year ending September, 1880, the amount of rain that fell 
("39 inches) was considered to have conduced to the healthiness of that period by 

Sanitation. ^ ' ^ ^ . . ... ,, ,_ 

flushing and cleaning out the drains, carrying away much, if not all, the decom- 
posing vegetable and other matters which accumulate in such quantities. — (XX. 24.) 

In that to September, 1876, the climate is described as being ' one of the healthiest and most 
delightful in the world.' The summer months are not very hot; the maximum of the last six, namely 
on the 29th and 30th July, was 88° Fahr., and on the nights following these days 
the mercury fell to 79° and 81°. It is always so here ; the days are hot, but there 
is enough fall at night to make the air pleasantly cool, yet not enough to produce chills. Even in 
the hottest weather there is a refreshing sea-breeze, which gives bloom to the cheeks and vigour 
to the frames of the most feeble. Dr. Scott has seen delicate children brought here almost dying, 
who have got well and strong in a short time; and delicate adults, who could hardly exist at 
home, or in other parts of China, quickly gain strength in this genial climate.' — (XII. 19.) The 
six months to September, 1878, were hotter than any corresponding period for ten years. — (XVI. 
26.) During the half-year ending September, 1878, the maximum temperature registered was 
98° Fahr., namely in July and August respectively; the lowest maximum 87°, namely in April. 
The absolute minimum, namely 58°, occurred in June ; the maximum reading of the lowest, 75° 
in August. Rain fell on 23 days ; the total amount, 39 inches. The summer was described as 
very mild in comparison to the heat endured at other ports, particularly Shanghai. — (XYIII. 75.) 
In that ending March, 1880, the actual highest day temperature recorded, namely 90° Eahr., 
occurred in December; the lowest monthly maximum, 66° Fahr., in February; the highest 
minimum, 68° in October ; the absolute lowest, 40° in January. Rain fell on 10 days, the 
amount of rainfall for the period being 10"34 inches. — (XIX. 11.) 

In the six months ending September, 1871, diseases of the zymotic class were those which 
were most prevalent. Of these, ague stood first as to number. Next in frequency, and 

Heaithand f^r surpassing ague in severity, came venereal diseases and their sequelic. Then 

Diseases. jj^ j^j^g order of their frequency, diarrhoea, dysentery, and boils, the latter very 
troublesome during the hot season. Among the natives, choleraic diarrhoea prevailed, in some 
cases developing into cholera. Only one case of small-pox among foreigners, and it imported 
from Shanghai. The conditions of general health were described as unprecedentedly bad ; 
there being 399 cases of illness during the period, out of an estimated foreign population, 
including the shipping, of 500 persons ; the death-rate, however, was small. The general type 
of disease was intermittent. In connection with this circumstance Dr. Scott notices the 
fact of the season having been unusually rainy. — (II. 8.) In the half-year ending September, 
1872, miasmatic and enthetic diseases were those most frequently met with. Diarrhoea 



LOCAL CONDITIONS IN RELATION TO PUBLIC HEALTH. 61 

was unusually prevalent, witli, and in the absence of, affection of the liver. So also in regard to 
dysentery. Boils, attended by much constitutional disturbance, were of frequent occurrence. 
Two cases of small-pox were noted, but the disease did not occur in epidemic form, — (IV. 87.) 
In that to September, 1874, the most prevalent diseases were remittent and intermittent fever, 
and diarrhoea. Dysentery was stated not to be at all common at the settlement. Cholera 
prevailed severely among the natives during five months, but Europeans did not suffer much from 
it. The disease had not been epidemic since 1865. — (VIII. 65.) Daring the half-year ending 
March, 1876, the general health was recorded as good, although the number of deaths was 
unusually large. The remark occurs, however, that the European population of the settlement 
being about 150, including men, women, and children, many years pass without a death among 
them. On this occasion there were four, namely, by abscess of the liver, 1 ; croup, 1 ; albumin- 
uria ; puerperal fever, 1. The summer of 1875 was marked by a very severe epidemic of 
cholera among the Chinese. A few cases of that disease occurred among the sailors. The only 
foreign resident attacked lived in the Chinese town. — (XI. 29.) 

In the half-year to September, 1876, zymotic diseases were again the most numerous. The foreign 
population, still about 150 in number, furnished 270 cases of illness. Intermittent fever is common 
among sailors who sleep on deck with little covering over them, and who swim under the hot sun. 
Whether protected or not by a hat, a man who swims at an unseasonable time is almost certain to 
be prostrated by fever within twenty-four hours. Apart from these causes, fever is rare, and 
ague is almost unknown. Bnthetio diseases stand first in severity and importance. They are 
almost entirely confined to sailors. — (XII. 19-21.) In. the corresponding period to March, 1877, 
miasmatic diseases decreased in prevalence considerably. This remark applies more especially to 
intermittent fever and diarrhoea. Small-pox prevailed extensively among the Chinese in the sur- 
rounding districts. In the settlement itself, however, only one case occurred among the foreign 
residents. — (XIII. 8.) From April to Septembei', 1877, the majority of diseases observed be- 
longed to the zymotic class. Continued fever and diarrhoea were somewhat prevalent, but cholera 
which affected many other parts of China did not occur at this settlement. Among the Chinese 
in the neighbouring districts, the disease is endemic. It did not occur among them in larger 
numbers of cases than usual. Boils, which, as already noticed, are usually very prevalent in 
summer, were not observed on this occasion. Among the shipping there were several cases of 
continued fever. Among the persons employed in diving operations there have been several cases 
of a peculiar form of paralysis, to which the name of '' the Pressure ■" has been applied. — (XIV. 69.) 
During the months of October and November, 1877, choleraic diarrhoea and cholera prevailed 
extensively and fatally among the native Chinese. Among the foreign residents only one case of 
cholera occurred, namely, in a child eight years of age. Diarrhoea was very prevalent among 
them at the time. Altogether, the half-year to March, 1878, was considered very healthy. — (XV. 23.) 
In the summer-half of that year there was no unusual amount of sickness, notwithstanding the 
more than usual heat of the period, though cases of sun malaise were sufficiently common. 
Diarrhoea and intermittent fever prevailed to their usual extent ; but no epidemic of any kind 
occurred. — (XVI. 26.) In the six months to September, 1879, cholera, a few cases of which 
usually occur during the summer months, did not present itself ; there was no case of heat- 
apoplexy, and only the usual amount of diarrhcea and intermittent fever. A rather curious 
epidemic of influenza attacked the children living on one side of the river ; the children living 
on the opposite side and on Double Island remaining unaffected thereby. — (XVIII. 75.) For 
the half-year to March, 1880, the health of the port was uncommonly good, there having been 
hardly any serious cases either among the residents on shore, or in the shipping. Dr. Scott 



62 EPITOME OF MEDICAL REPORTS. 

writes : ' Too much cannot be said of the healthiness of Swatow during the winter months. • 
In the same Eeport he remarked that ' many of the foreign women residing in the south of Chma 
were unable to nurse their childreUj either on account of insufScient secretion of milk or insufficient 
nourishment in it. Many fine children were for the first few months reared on preserved milk. 
Elsewhere, however, experience is in favour of having native nurses.' — (XIX. 11-15.) During the 
period to September, 1880, the health of foreigners was unusually good. Fevers and the ordinary 
summer diarrhoea were less frequent and less severe than usual. No epidemic prevailed. It has been 
a healthy season f .r natives also ; there was no serious illness of an epidemic character, ' a circum- 
stance rather remarkable, considering the extreme dirt of Chinese towns and villages.' Cholera 
was entirely absent, although usually endemic during the hot months. While health 
conditions were thus satisfactory in regard to man, a grievous epizooty prevailed among cattle, 
and a plague of caterpillars affected the fir-trees around the settlement. — (XX. 24.) In that to 
September, 1881, the diseases enumerated included diphtheria, typhoid, dysentery, and varicella. 
An outbreak of the latter occurred among the resident children on Double Island. — (XXIT. 4.) 



CANTON. 

The city of Canton is situated in latitude 23° 7' N. and longitude 113° 15' E., on the northern bank 

of the Canton river, and about 70 miles from its mouth. To the north of the city the country is 

hilly ; to the south there is an alluvial plain formed by the delta, and intersected 

'by ramifications of the river. The land here, as compared with other parts of this 

province, is low and humid. The country people are chiefly engaged on rice plantations, and 

reside on the plains not far from their farms. According to the Eeport to September, 1873, 

all the available land, plains, and valleys of this province have long been under cultivation for 

rice-plantations. Wherever we go, vast tracts of paddy-fields meet the eye. There 

are no neglected marshes, jungles, and tracts of country with stagnant water ; 

the country has been under cultivation for centuries.' — (VI. 41-42.) 

In the Report for the six months ending September, 1872, the remark occurs that ' many of 
the fevers of the Chinese city must have their origin in overcrowding and bad sanitary condi- 
tions. These conditions, though sometimes regarded as harmless, because they 
have given rise to no epidemics of cholera, and, as far as we know, to no marked 
forms of typhoid fever, have much to do with the production of the severe fevers that prevail 
every summer.' — (IV. 70.) 

The following represents the condition of the Chinese prisons in that city in 1872. In that 
part of the prison called the Wee-ki, the prisoners were kept in separate enclosures in- 
side the building. Thirty or forty prisoners were confined in spaces not more 
than 15 to 20 feet square, surrounded partly by posts for the admission of air. 
The men were in filth, rags, and misery, the stench from them most offensive. Of their number, 
one was dying of fever, another of dropsy and diarrhcea. Eever was very rife, but some of the 
old prisoners live and thrive, while the new-comers, unaccustomed to the prisoned atmosphere, 
often die.— (III. 21.) 

In the Report for the ha]f-yea,r ending March, 1872, Dr. P. Wong wrote as follows : ' Since 
the sewerage question has been so much in agitation in connection with typhoid or enteric fever, 
^^^^^ it may be well to mention that in Canton large numbers of the native popula- 

tion are daily using water and inhaling air charged with the impurities of human 



LOCAL CONDITIONS IN RELATION TO PUBLIC HEALTH. G3 

excreta, apparently with utter impunity. River-water is greatly used wherever it can be obtained, 
but that used by the crowded boat population along the different jetties is extremely filthy, and 
must be largely contaminated with human and other impurities. Although comparatively pure 
.water can be easily obtained in the middle of the river, or a little farther from the jetties, the 
sampan people prefer to get it by the side of their own boats, simply because they receive no 
harm by the practice. They do not suffer from diarrhoea and fever more than others, but rather 
less. The water they use, moreover, bears no comparison with the filthiness of the different 
creeks that ramify into different parts of the city. He will instance, as an illustration, one creek 
which has been under his observation for some years. This creek, called San-t'sung, is not far 
from the foreign settlement. It is comparatively narrow and crowded with boats ; on both sides 
of it are innumerable houses, chiefly brothels ; the alvine dejections and other impurities of 
thousands of inhabitants along it are daily discharged into the stream ; yet the water, too dirty 
even for washing, is daily used for culinary purposes, without being filtered or precipitated with 
alum, as is done in Shanghai. Here we should expect the prevalence of such diseases as typhoid 
fever and diarrhoea occurring often enough to excite attention ; but Dr. Wong has been told by 
persons who have good opportunities of knowing these people, that they are not more subject to 
fevers and other diseases than are other persons, and that this impunity is one of the reasons for their 
continuance in the use of such water. A detailed examination of this creek, and the disgusting 
habits of the inhabitants, would almost unsettle one's idea of the connection between typhoid 
fever and polluted water. In the south of China, it is only in Canton that water of such a filthy 
character is so much used.-" — (III. 21.) 

In the diet of the people, ]873, the principal article of food was rice. With this was eaten 
a little fish, fresh or salted; some vegetables, fresher pickled; some meat, most commonly pork, 
sometimes ducks or fowls, and sometimes, though less often, beef. Among the 
better classes less rice and more meat is eaten. The poor people replace part of the 
rice with sweet potatoes {Convolvulus hatatas) and tare (calaclium). G-round-nut oil {Arachis 
liijpogea) is in most common use for ordinary purposes, and next to it lard. Potatoes are 
eaten in small quantities, and not as a common article of food. Fresh vegetables have been in 
use from time immemorial. Fish is very little eaten among the poorer classes, and not in 
abundance by those who are well-to-do.^ — (VI. 42.) 

In the Report to September, 1871, the climate was described as generally healthy. The 
summer had been cool, with an unusually long period of rain, lasting from the middle of May 
to the end of September. — (II. 70.) The summer half of 1872 was hot; the 
heat in July and August particularly oppressive ; often 94° Fahr. in the shade. 
Except in the early part of the season there was very little rain. The cold weather set in un- 
usually early, in the first part of September, and it remained cool for nearly the whole month. — 
(IV. 68.) The summer of 1873 was remarkable for the most terrible thunderstorm that had 
occurred for many years. It took place on 13th of May, and extended to Hong Kong, Macao, 
Pat-shan, and Shin-hing. The rainfall in the summer was excessive ; with slight interruptions 
it rained from April to September ; much of the crops was in consequence injured, and a great 
part of the adjacent country flooded. The persistence of rain, however, kept the weather cool. 

(VI. 48.) During the six mouths to September, 1877, the average maximum temperature was 

89° Pahr., namely in August, the lowest maximum 76° in April ; tho highest average minimum 
82° in August, the absolute minimum 68° in April. The hottest day occurred in August ; the 
thermometer then stood at 97° Fahr. In the whole period rain fell on 88 days, the total amount 
701 inches, as against 92 days and 37'4 inches in the same period of 1876 ; that for the entire 



64 EPITOME OF MEDICAL EEPORTS. 

year ending 30th September was 772 inches; the number of rainy days 130. Nearly all the 
rain occurred during the last six months ; the greatest fall on any one day, 5 inches^ 
namely on 8th of May. During the summer months the range between the day and night 
temperature was very limited. The ordinary summer is long and hot, the heat unameliorated by 
sea-breezes. Rain usually begins to fall in Aprils and continues to the end of August. The 
prevailing wind is from the south, varying from south-east to south-west, though the hot westerly 
wind comes in occasionally. The rainfall was excessive j the rivers unusually flooded. No actual 
typhoon occurred, but the month of August was very squally. Notwithstanding the high tempera- 
ture, if the sky is clear with a good south or southerly breeze, the heat is bearable ; but if the 
days are cloudy and the atmosphere heavy, evaporation is checked and the heat becomes most 
oppressive. On the 13th of May an inundation of the greater part of the city and of the 
adjoining low-lying country districts took place. It was owing to about 000 feet of the bank of 
the North river which flows through Ts'ingyiien, a district about 60 or 70 miles from 
here, having given way on 2{3th of the previous month. No similar breach in that embank- 
ment had occurred for 39 years. On this occasion 10,000 human lives were said to have been 
lost by the disaster.— (XIV. 57.) 

In the half-year ended March, 1878, the highest average monthly temperature was 82°, namely 
in October, the lowest maximum 56° in January; the highest average minimum in the period 72° in 
October, the actual minimum 40° in January. The coldest month was January. The lowest 
temperature, namely 38° Fahr., occurred on the 19th and 20fch of that month. Rain fell on 81 
days; the total rainfall 207 inches, as against 48 days and 7'1 inches in the corresponding period 
of 1876-77. In the last four days of March the rainfall amounted to 8'8 inches. A heavy thunder- 
storm with much rain occurred in the night of 26th and 27th of that month, 6 inches of rain 
falling in six hours. The winters in Canton are generally very fine, and are looked forward to 
with pleasure by foreign residents as a most agreeable change, after long and trying summers. 
This winter, however, was an exception. Instead of fine weather such as usually prevails from 
September till January, drizzling rain or mist prevailed, with only a few intervals, from November 
till March. In October and November the weather was comparatively warm ; in December the 
temperature for the first two weeks was unusually high — the thermometer for several days at 
80° with a southerly wind blowing. After this the cold weather set in steadily ; in January the 
thermometer often stood at 39° in the morning, gradually rising to 46"' and uO° in the course of 
the day. The cold was intensified by the presence of rain; and many beggars were said to have 
perished from the severity of the weather. Throughout February the weather was still very cold, 
but not so severe. — (XV. 12.) 

In 1871 the foreign community, exclusive of the shipping, numbered 150; the diseases among 
them were such as usually occur in hot climates. The long continuance of the rainy season was try- 
Health and i'lg to persons who were liable to rheumatism, neuralgic affections, or diseases of the 
Diseases. respiratory organs ; but generally, among both foreigners and natives, the half-yeai 
to September was healthy. An epidemic of small-pox broke out in the city in the latter part 
of 1870; it extended to the towns and villages for many miles around, but mortality by it 
was moderate. Only one foreigner took the disease. At the same time there was also a con- 
siderable prevalence of measles in the city. Cholera had not visited the city for many years, 
and in nothing like epidemic form since 1858. The diseases prevalent among foreigners were 
diarrhoea, fevers, rheumatism, catarrhs, dysentery and liver affections. Three cases of whooping- 
cough occurred among their children — a rare phenomenon, as no case of the disease had been seen 
during the previous ten years. Among the Chinese population the prevailing diseases were 



LOCAL CONDITIONS ]N RELATION TO PDBLIC HEALTH. 65 

intermittent and remittent fevers, diarrhcea, dysentery, summer cliolera, oplithalmia and boils. 
Ophthalmia, though not confined to any season, is most prevalent in summer. With the recurrence 
of milder weather in September the severer forms of fever disappeared ; they were succeeded by 
catarrhal affections and mild intermittents. All diseases had more or less of an intermittent type. 
The fevers from which foreigners suffered were of the intermittent type. Among the Chinese in 
the city remittent fevers, sometimes of virulent character, were of frequent recurrence ; in fact 
the forms of fever which affect the natives in the summer season are in some cases of the most 
intractable nature. Dysentery and diarrhcsa among the natives of China are mild, while congestion 
and inflammation of the liver, so fatal to foreigners, are rarely, though sometimes, met with among 
them. Leprosy, common among the Chinese, has never been known to affect Europeans here. Stone 
in the bladder is extremely common in this province. The prevalence of this affection has been at- 
tributed to the presence of lime in the potable water. Against this theory, however, is the fact that 
the natives only use water that has been boiled, and consequently the lime in it is thus depo.sifced. — 
(II. 70). In the winter of 1871-72 the health of the foreign residents was excellent; this remark 
applying to children as well as adults. The absence of the usual diseases incidental to childhood, 
including measles, whooping-cough, laryngeal affections and scarlatina, was remarked upon, the 
latter disease being so rare that the medical oiiicer had not seen a case of it at Canton during the 
preceding ten years. The health of the Chinese was also particularly good ; and yet the season 
was described as having been unusually severe. Throughout the six months to March, 1872, 
there occurred no epidemic of any kind ; small-pox appeared in February, but only in scattered 
cases. Associated with intermittemt fever among the Chinese was diarrhoea^ a combination very 
common in the natives of this province. — (III. 19.) 

In the half-year to September, 1872, the general health of the adalt members of the foreign 
community was, ' as usual/ very good. Some cases of fever, dysentery, catarrh, bilious conges- 
tion, etc., constituted nearly the whole amount of sickness observed among them. With Shamien and 
other healthy localities along the river-side as places of residence, houses well adapted for warm 
climates, temperance in diet, and care in avoiding exposure to the sun, foreign residents may, 
and generally do, enjoy very good health throughout the year. Among the children, besides the 
usual cases of diarrhoea, coughs, febrile disturbance, and other disorders incidental to the period 
of dentition, a few cases of great severity occurred, and terminated in death. An unprecedented 
number of deaths occurred, namely four adults and four children, but not all from climatic disease. 
Among the diseases noted are boils, small-pox, neuralgia, and fevers. — (lY. 68.) Leprosy is 
endemic in the province of Quang Tung (1873) ; malarious fevers very prevalent. Among the 
foreign community, as in previous summers, there was very little sickness. Among the native 
population of the city there also was very little sickness during the continuance of the seasonal rain ; 
but as soon as it ceased, and was succeeded by heat, numerous cases of fever appeared among the 
latter. In May there was a great prevalence of diarrhoea. After the storm of the 13th, little 
sickness occurred till July, when an interval of great heat intervened; with it fever and diarrhoea 
prevailed. Then followed a period of heavy rainfall. In September the heat was intense, 
especially during the first ten days, and then fever again appeared among the native population. 
As this is the time of the change of the monsoon, the weather was unhealthy, and so, with the 
occurrence of the north wind, sore throats, coughs, catarrhs, and bronchitis became prevalent. 
By some old residents, September is regarded as the worst month of the year, but the 
September of this year was the hottest that had been experienced for many years. Still, taken 
as a whole, this has been an unusually healthy year for the Chinese population. Measles had, 
however, been more than usually prevalent, but no other epidemic occurred. A few sporadic 

9 



66 EPITOME OP MEDICAL REPOBTS. 

caseR of cholera appeared, but they were very rare. This part of China is not considered to 
be favourable for persons affected with phthisis. — (VI. 41.) 

In the six months to September, 1877, the general health of the community was fairly good. 
The prevailing diseases among the foreign residents were diarrhoea and intermittent fever ; a few 
cases of subacute hepatitis also occurred. Boils affected a considerable number of persons, the 
young and the full-grown being alike liable to them. Among the Chinese, small-pox continued 
from the previous winter till the month of April. In January, chynanche tonsillaris affected 
the Chinese. Measles occurred in May. In that month also bronchial affections were numerous ; 
towards its end diarrhoea appeared, and thence continued throughout the summer. Dysentery 
persisted through May, June, and July. In August and September, diarrhoea, dysentery, 
and intermittent fever prevailed, the type of fever increasing in severity later in the season. 
— (XIY. 57.) 

In the six months ending March, 1878, the general health of the foreign community was 
fairly good. Among the Chinese, the general state of health, was also good, diseases of a 
severe type not of frequent occurrence. The most prevalent complaints were fevers, diarrhoea, 
and catarrhal affections. A few cases of dysentery occurred. Among the Chinese population 
the prevailing diseases were catarrh, bronchitis, rheumatism, and fevers. In October, owing to 
the unseasonable warmth, and changeableness of the weather, there was a great prevalence among 
the latter of catarrhal affections, as also among the foreign residents. Intermittent fevers were 
quite common in November and December. With the approach of the cold season, dysentery and 
diarrhoea gradually disappeared. There was no epidemic of small-pox or measles. — (XV. 13.) 

In the spring months of 1879, confluent small-pox prevailed extensively among the native 
Chinese ; and, on the opposite shore of Honan, nearly depopulated two villages. During the 
summer season, a severe form of continued fever, in some respects resembling cholera, prevailed. 
During the months of August and September, a peculiar form of remittent fever affected both 
Chinese and foreigners. With the latter it was observed more particularly during convalescence 
from other diseases, such as acute diarrhoea, dysentery, etc., but especially amongst parturient 
women. And yet the season was exceptionally free from the ordinary complaints wbich. 
are naturally expected in this climate. There have been no cases of dengue. — (XVIII. 56, 57.) 

During the six months ending March, 1880, the state of public health was very good, only the 
ordinary diseases incidental to the climate of South China occurring. In the spring, ulcerated 
sore throat was epidemic. Five cases of measles occurred during the half-year, namely, three 
in adults and two in children. Gastric and gastro-enteric fever in children, not depending on the 
presence of worms in the intestines, came under treatment. — (XIX. 16.) During the half-year 
ending March^ 1881, an epidemic of small-pox occurred, and raged ' to an unprecedented extent ' 
in and around Canton. Otherwise, there was very little sickness, ' notwithstanding the fact that 
throughout China the climate of Canton is considered very unhealthy.' The usual autumnal 
epidemic of dengue was absent ; the prevailing diseases intermittent fever, measles, rheumatic 
affections, and opbthalmia. — (XXI. 71, 72.) According to the Report for eight months ended 
March, 1882, an unusually severe form of remittent fever to a limited extent prevailed among 
foreigners. Among the Chinese there has been no epidemic since the winter of 1880-81. Syphilis 
prevails to a frightful extent in the city. — (XXIII. 33.) 



LOCAL CONDITIONS IN RELATION TO PUBLIC HEALTH. 67 



HOIHOW. 

HoiHow is situated on tte north-east coast of the island of Hainan^ in latitude 20° 3' 13" N., 
longitude 110° 19' 3" B. It is the seaport of the city of Kiangchow, 3 miles distant, which 
was opened for foreign trade in 1876. The walled city of Hoihow is built on the „ 

1 1 n n n 1 Topography. 

south bank of one of the mouths of the Tingan river ; it has a population of about 
12j000 inhabitants. The majority of the houses are only one story high, but Bui'opeans have 
been able to obtain for themselves those of two stories. They are built close to the water's edge, 
upon a sandy soil. They were flooded by reason of a sudden rise of the river in September, 1880, 
but a similar occurrence was unknown during the ten preceding years, Eesidence in these houses 
has so far not proved injurious. Within ten minutes' walk the ground rises considerably. This 
elevation was recommended as furnishing an eligible site for houses for the foreign residents ; it 
also possesses good springs of water. From a sanitary point of view, Hoihow 
does not compare unfavourably with other Chinese cities. The streets are well- 
paved and drained; a main channel runs through the town; it has branches in the different 
streets, and discharges its contents into the river. Householders subscribe to keep the drains in 
repair. Nothing but dirty water escapes into them, all night-soil and refuse being collected and 
used as manure. — (XXI. 73-75.) 

In 1881, Dr. Aldridge wrote : ' It became a question whether one should remain indoors and 
forego the pleasure of taking any outdoor exercise, or experience the unpleasantness of having to 
walk along streets where the pestilential odours emanating from the drains and the refuse thrown 
from the houses must have greatly favoured the spreading of a disease such as cholera. The 
condition of the streets was greatly aggravated at the time of the Yli Lan, or All Souls' festival, 
by an increase in the number of fruit and vegetable sellers lining the streets, and by their 
throwing both into the gutters whenever they become unsaleable.' The state of the town was 
described as filthy.— (XXII. 6-8.) 

The people are poor. Cattle are bred for agricultural purposes, hence foreigners have diffi- 
culty in obtaining cow's milk. Goat's-meat can always be had, but as there are no sheep on the 
island, the want of mutton is much felt by foreigners, who entertain a certain pre- ^ ^ 
judice against the pork sold here. The supply of sucking-pigs is large, and 
they are in considerable demand. There is always an abundant supply of poultry and 
vegetables to be had in the market, and the varieties of fish of good quality are numerous. 
The water obtained from the wells in Hoihow in 1880-81 was brackish, and not fit 

. , Water. 

for drinking; but very good water could be obtamed from sprmgs a lew minutes 
walk from the town. The supply from these springs was not affected by the dryness of the 
season. — (XXI. 73, 74.) Many of the Chinese prefer to drink the foul water close to their houses, 
rather than take the trouble of bringing drinking water from the springs a short distance from 
the town.— (XXII. 8.) 

According to the Eeport for the six months ending March, 1881, the climate of this place was 
considered to be favourable for persons suffering from chest affections. Dr. Aldridge re- 
cords the case of a man who came to Hoihow, suffering severely from asthma and climate, 
bronchitis, who speedily improved in health, and gained 27 pounds in weight; 
also that of another man who arrived on the island three years before, suffering in a similar 
manner, and who since that time had not been a day off duty on account of sickness. On the I7th 
and 18th October, 1880, heavy rains and squalls prevailed; while off the north-east coast of the 

9—2 



68 EPITOME OF MEDICAL REPORTS. 

island a destruofcive typhoon raged. Dr. Aldridge considered that Hoihow is not such an un- 
pleasant place of residence as might be imagined. During the six months from October, 1880, 
to March, 1881, the weather was fine and clear; temperature moderate, and a more agreeable 
climate ' it would be impossible to find in any part of the world.' Hoihow presents numerous 
facilities for outdoor exercise. The average temperature for the period including October, which 
was a hot month, was about 68° Pahr. In February the thermometer rose in one day to 87° Fahr., 
a south-east squall and fall of very large hailstones occurring at the same time. In March the 
lowest temperature was 52° Fahr. The number of days on which rain fell in the whole period was 
only 22. The wind chiefly north-east ; the tides very irregular. As a consequence of the unusual 
dryness of the season the rice crops suffered considerably. — (XXI. 74-77.) From April to 
September, 1881, the summer was very long and trying; thermometer only on two occasions 
during the six months below 82° Fahr. ; its average height throughout the period being 85° Fahr. 
From April till the end of June, violent thunderstorms were of frequent occurrence. In the whole 
six months rain fell on 55 days ; oi-, for the whole year from 1st October, 1880, on 77. The rainfall 
usually attended a thunderstorm. In this period the maximum temperature recorded was 95° 
Fahr. ; this occurred in May, and again in June ; the lowest of such maximum, namely 86°, 
occurred in September. The highest minimum, 82°, occurred in August; the actual lowest 
reading, 67°, in April. — (XXII. 6-10.) In the six months to March, 1882, the maximum tempera- 
ture of the period, 83°, occurred in October — the lowest of such maximum, 74°, in February ; the 
lowest, 54° Fahr., in February — the highest of such minimum, 77°, in October. The weather 
during the last three months of 1881 was very disagreeable, the rainfall the greatest in quantity 
since the opening of the port. October set in with a strong north-east blow which lasted four days. 
November was a wet month, differing in that respect from the same month in 1880, when no wet 
day occurred. The weather during this period has been very pleasant ; for the most part fine, 
cool and bracing. — (XXIII. 30.) 

Since the date of opening Hoihow as a port, 1 6 foreigners have been resident for different periods 
of time — that is, between 1876 and March, 1881. Not one of them suffered from serious illness. 

Health aodj ^101' "^id any of their number have to leave the port on account of ill-health. In the 
Diseases. interval, there was no medical man nearer than Hong Kong, distant 270 miles. The 
most prevalent diseases were those of the skin and eyes. A large number of natives applied to Dr. 
Aldridge, and had no hesitation about taking foreign medicine. There is much leprosy in the 
neighbourhood. Small-pox is much dreaded, a severe epidernic of that disease having destroyed 
many lives five years before. — (XXI. 73, 74.) From April to September, 1881, the health of the 
foreign community was reported very good. A few cases of acute diarrhoea occurred among them, 
but these attacks were readily amenable to treatment ; all other affections were trivial in character. 
The constitutions of those living in Chinese houses were enfeebled, as a result of protracted heat, 
excessive perspirations, and sleepless nights ; with improved houses, however, these evils would 
be to a certain degree lessened. In the month of August an epidemic of cholera occurred • it 
continued throughout September. The disease was considered to have been imported from 
Bankok. Four cases of heat apoplexy and one of intermittent fever occurred on board H.M.S. 
Magpie, but there were no deaths. The French gun-vessel Par.sei;aZ arrived from Haiphong with 
a mild case of typhoid fever. In June and July many cases of mumps occurred among the 
Chinese, adults as well as children being attacked. — (XXII. 6-9.) In the six months ending 
March, 1882, the health of the foreign residents, still numbering 16, was very good. Diseases of 
the respiratory organs were more prevalent than usual, being attributed to the dampness of the 
weather at the end of 1881. Deaths from malarial fever occurred among the Chinese troops sent 
to Hainan.— (XXIII. 30.) 



PART II. 

MEDICAL. 

HISTOEIOAL NOTICES OP MEDICINE IN CHINA, AND OF OEETAIN 

EPIDEMICS, ETC. 

The art of healing was practised among the Chinese in their prehistoric times, but the first quasi- 
scientific efforts of which we have any written record belong to the period of the Chow dynasty, 
B.C. 1122-260. The physicians of that dynasty classified diseases under the four seasons of the 
year — headaches and neuralgic affections under spring ; skin diseases under summer ; fevers and 
agues under autumn; and bronchial and pulmonary complaints under wwi/er. They treated the 
various diseases that fell under these headings by suitable exhibitions of one or more ingredients 
taken from the five classes of drugs, derived from herbs, trees, living creatures, minerals, and 
grains, each of which contained medicines of five flavours, with special properties as follows : 
sour for nourishing the bones ; acrid for nourishing the muscles ; salt for nourishing the blood- 
vessels ; bitter for nourishing general vitality ; and sweet for nourishing the flesh. It was a 
standing regulation that all potions administered to the ruler of a State should first be tasted by 
the Prime Minister, and the public at large was warned against rashly swallowing the prescrip- 
tion of any physician whose family had not been for three generations in the medical profession.* 
About B.C. 200 the 'First Emperor' of China issued orders for the destruction of all existing 
books, with the exception of works treating of medicine, agriculture, divination, and the annals of 
his own house. In this dynasty a famous physician was named Hua. He was celebrated for his 
administration of drugs, and his use of acupuncture and counter-irritants. ' If the sick man is 
suffering from some internal complaint and medicines produce no satisfactory result, then Hua 
will administer a dose of hashish, under the infiuence of which the patient becomes as it were in- 
toxicated with wine (ancesthetised ?). He now takes a sharp knife and opens the abdomen, proceed- 
ing to wash the patient's viscera with medicinal liquids, but without caiosing him the slightest j^ain. 
The washing finished, he sews up the wound with medicated thread {antisoptio ?), and puts over it a 
plaster, and by the end of a month or twenty days the place has healed up.' For indigestion he pre- 
scribed ' three pints of a decoction of garlic and leeks,' with the very natural result, considering 
the quantity, that vomiting was induced. But one of his prescriptions led to a result disastrous 
to himself. Having been consulted by Ts'ao Ts'ao, on account of certain cerebral symptoms, Hua 
declared that they arose from wind, that the seat of the disease was the brain, where the wind 
collected, unable to get out ; he accordingly proposed to his patient that the latter should swallow 
a dose of hashish, and that then, with a sharp axe, Hua should split open the back of his head and 

* From ' Historic Cliina,' by R. A. Giles, p. 9. It is considered that the information thus quoted from the able writer named will 
enhance the value of that taken directly from reports by medical officers, the object of this epitome being to make that information aa 
complete as circumatauces admit of, 



70 EPITOME OF MEDICAL BEPOETS. 

let tlie wind out — thus the disease will be exterminated. Whereupon Hua was thrown into prison, 
where he died. Ts'ao Ts'ao never recovered from the disease for which the heroic treatment just 
mentioned was destined. 

Under the Sung dynasty, A.D. 960-1280, the functions of magistrates acting in their capacity 
as coroners were more fully defined than they had previously been ; the study of medical juris- 
prudence was stimulated ; medicine^ and the art of healing generally, came in for a considerable 
share of attention. Voluminous works were written on therapeutics. Inoculation for the small- 
pox was known to the Chinese at least since the early years of this dynasty, if not earlier. It was 
also under the Sungs that the first work on acupuncture was published. 

Under the Mings, a.d. 1370-16.50, the ' Chinese Herbal' was prepared. This is a compilation 
from the writings of no fewer than eight hundred preceding writers on botany, mineralogy, ento- 
mology, etc., illustrated and arranged under categories. 

Under the Penal Code, as at present in force, ' the doctors' presci'iptions must be made up 
according to recipes sanctioned by established practice.' Homicide in a brawl is visited with 
strangulation. The death of a patient under the hands of a doctor would come under this pro- 
vision. If, however, it could be shown that the latter had wantonly deviated from the established 
rules of practice, he would be beheaded.* 

Dr. Macgowan writes : ' More than a score of centuries before Hippocrates wrote of " critical 
days," the Yellow Emperor, Hwangti, is represented as referring to the same subject, namely 
crises in disease, and the natural tendency which the body has to cure itself by critical evacua- 
tions at certain periods. The occasion on which his Imperial Majesty thus expressed himself is 
said to have been when conversing on the subject of physiology and pathology with C'hipe, his 
physician and minister.' Since the dawn of authorship there has been a succession of medical 
writers, but no separate caste existed to hand down the earliest observations. An old Chinese 
essay on Epidemics is noticed. That work was by Wu Tuhsin, a physician of Soochow. — 
(XXII. 23.) 

In the Report on Wenchow, April to September, 1881, Dr. Macgowan gives much information 
deduced from Chinese records on the subjects of epidemics, and medicine generally. He gives 
a chronological record of epidemics noted as having occurred in the province of Chehkiang from 
A.D. 95 to ISG-i, referring also to the nature of each, and the season of its occurrence. The 
term by which epidemics are expressed means ' diseases which affect everyone at the same time.' 
The list comprehends numerous maladies, and generally indicates that the epidemics were 
sequels of droughts, floods, famines, or civil war. They were of more frequent occurrence in 
the maritime regions than in the hilly districts ; many of them had also a limited area. The 
mode of transmission of the ' materies morbi ' is given in only one instance ; on that occasion 
a pestilence was conveyed from Hangchow to Sungyang by female children purchased as slaves. 
The ' germs ' [gjiccificjjoison ?) of the disease are thus considered to have been conveyed by clothes ; 
and in the Chinese work ' Pentsao,' in the chaptei- on Toxicology, old clothes are included as among 
the poisons. For 'several tens of years' Wenchow suffered every spring and summer from a con- 
tagious malady, which, from the nature of the allusions to it, was without doubt small-pox ; during 
its prevalence ' no one ventured out at night lest a pestilential demon might be encountered.' 
In 1579 a magistrate instituted an inquiry on the subject, and on the advice of 'men of age and 
experience,' directed the adoption of certain ' sanitary ' measures, one of which was the 
'erection of a special temple to the five demons of epidemics.' That temple was erected in a 
month, and the plague disappeared. Eeference then occurs to the appearance of a plague in the 

Op. cit, pp. 33-160, 



HISTORICAL NOTICES OF MEDICINE IN CHINA, ETC. 71 

sixth year of Kautsa, i.e. a.d. 591^ and to the simultaneous appearance in the sky of ' the five 
mighty ones,' namely 'heaven-sent demons, agents of the five epidemics, to wit those of spring, 
summer, autumn, and pestilences in general/ During that dynast-y the Sui and the Tano 
temples were dedicated to ceremonies for averting the pestilential wrath of these ' mighty ones,' 
now styled ' supernaturals/ In wealthy cities, Ningpo for example, ' the demons of pestilence' 
are borne in processions of an imposing character; and occurring as this procession dees in hot 
weather, its observance is itself often a source of sudden disease. According to the latest 
local gazetteer, worship at the Temple of the Demons of Pestilence does not now suffice to ward off 
the diseases to which the city is described as being particularly exposed, owing to atmospheric 
vicissitudes, albeit it is the most cleanly city in the empire. — (XXII. 2-3, 29, 30.) 

In the year 1295 the city of Cbangchau in Kiangsu was ravaged by an epidemic. On 
that occasion Chang Tzuchi, Minister of State, established a dispensaiy and directed the 
gratuitous issue of medicines ; but in vain, and so the people repaired to the Temple of the 
Demons of Pestilence. Temples to the Yo wang, or Princes of Medicine, are everywhere to be 
met with in China. The earliest of those to whom such temples were erected was Pien Ch'iao, 
who flourished in the reign of We Lih, B.C. 468 — 440. Pien Ch'iao is credited with anatomical 
knowledge obtained by dissection, and with the theory of the pulse, as also with the practice 
of acupuncture and the moxa. Dr. Macgowan adds, however, that such knowledge is 
apocryphal. In a.d. 738 there appeared in the capital a singularly attired foreigner; attached to 
his girdle were calabashes, several tens in number. His fame reached the palace ; the Emperor 
sent for the foreigner, who announced himself as ' an obtained-doctrine man ' (teh-tao) from 
India. His name was Wbiku. His Majesty ordered his portrait to be taken, and conferred 
on him the title of Medicine Prince. A Pukien miscellany names a Medicine Prince Temple or 
Temple of Pien Ch'iao, also called Temple of Dr. Lu. Another says that the Medicine^Prince, 
or Pusa, was Wbiki;, who came from Sumatra. He is described as having teh-tao, the Buddhist 
term for one who has entered Nirvana. It is stated that he was not a Buddhist, however. 
During the reign of the usurping Empress Wu, in the latter part of the sixth century, a Taoist 
practitioner of medicine named Wei SHENCHtfN became celebrated as a monk, and for the 
cures he performed. Soochow boasts a medical Pantheon, which at the present time bears the 
name of the ' Temple of the Healing Kings.'— (XXII. 30, 32.) 

The general Chinese name for epidemics of all kinds is applied to plagues of a febrile and of 
a choleraic type. In mediaeval times such as occurred were for the most part accompanied by 
drought or famine. Thus in a.d. 791, during the Tsung dynasty, an epidemic happened with 
drought, when the wells at Poochow were dried up j it spread over the entire province. Other 
epidemics are recorded as having prevailed in parts of the province of Pukien, but they did not 
spread over the whole of it. In 1275 a disease, the nature of which does not appear, destroyed 
nearly one-half of the population of this province. In 1856 a severe epidemic prevailed at 
Puning, and at the same time a famine so intense that cannibalism was practised; in 1370 in 
Puning, in 1450 in Shaowu, in 1682 in Formosa. — ^(XIV. 33.) 

Epidemic frenzies of various kinds have occurred in China from time to time. An epidemic of 
this nature occurred a.d. 1464, a date, as remarked by Dr. Macgowan, ' nearly concurrent with 
the beginning of witch-mania in Europe, or that of the Bull of Innocent VIII.' Other epidemics 
of the same kind occurred in the years 1529, 1596, 1657 and 1753. In regard to the treatment 
of epidemics of this nature, recourse was had to drugs and counter-incantations, loadstone pills, 
purgatives, emetics, etc. Talismans and charms of various kinds were in use against the "■ disease.' 
Hartall, arsenic, and other medicines were carried in a belt, branches of the peach-tree hung up in the 



72 EPITOME OF MEDICAL REPORTS. 

house, while ''by music from gongs, drums, fireworks, or otherwise, demons may be driven off. 
Such delusions in China were nofc,as in theWest, intensified by religious fury, and women have seldom 
been regarded as addicted to sorcery, although etymologic ally the expression Yao, magical, elf, 
bewitching, and the like, is composed of 'woman' and 'winning.' In 1657 an epidemic was 
said to have been caused by wizards from the north of the Tang-tze, who appeared at Chinki- 
ang and Ohangchau. They possessed the power of fascinating or enchanting men whom they met 
abroad, so that, simply calling them by name, they were enabled to allure them to another city, 
and sell them all by means of a sort of ' hypnotizing.' The hypnotized being sold by their captors 
through SoochowaudChangchau brokers, led to the suppression of the practice. For a week,however, 
Changchau was troubled by 'spiritual'' manifestations. During night-time there occurred weird 
phenomena : rafters and tiles of houses shook with fearful noises ; phantoms, offensive in odour, 
appeared ; black demons assumed various shapes, as that of a fox ; these shadowy ogres smothered 
or wounded people, but attempts to smite them with swords only resulted in wounding the smiter. 
Then follow remarks on talismans and charms generally in relation to sorcery. In 1876 an 
epidemic frenzy of the nature just described occurred in the province of Kiangsu, and in 1881, 
according to the "^Shen Pau,'' two medical sorcerers exercised a powerful sway over a large tract of 
country bordering the Great Lake. They are dames, but assume and are accorded the title of 
unmarried women, implying that they are a sort of fairy. — (XXII. 32, 35.) 

Dr. Macgowan writes : ' It can be shown that neither army nor navy can be effective without a 
corps of duly qualified surgeons ; that anatomical knowledge is the first thing to be imparted ; 
and that such knowledge is to be acquired by dissections alone.' He relates how in the year 459 
the Emperor Hsiao Wu authorized certain ' experiments ■" of decapitation and subsequent 
'recovery" to be performed on prisoners. He quotes from ''Memoires concernant I'Histoire,' 
etc., (tome viii. p. 261), in regard to the evisceration, by order of a governor, of forty criminals, 
enceinte women, and children, for anatomical purposes, causing examinations of the viscera to be 
made by skilful physicians. In advocating the utilization of the bodies of persons capitally 
punished for dissection. Dr. Macgowan quotes in support of the practice the authority of the 
' P^ntsao.' It must be observed^ however, that the history given therefrom is less demonstrative 
than might at first sight appear. As ' evidence ' in support of the utility of post-mortem exami- 
nations, the highest medical authority the Chinese acknowledge, namely the ' Pentsao,' narrates the 
case of a man of rank who, as well as his slave, suffered from abdominal pains. The slave 
succumbed to the malady, and the master, opening the body, discovered a red-eyed white turtle, 
on which he tried the effects of various medicines, none of which killed the animal. By accident, 
however, it was discovered to be soluble in horse urine, from which he inferred that that excretion, 
hitherto unknown as a medicine, would dissolve the tumour that occasioned him so much pain ; 
he tried it, and was cured. Since that time equine urine has held a high place in the Pharmacopoeia 
for the treatment of visceral tumefactions and various other disorders. — (XXII. 48.) 

In the Report on Shanghai, January to March, 1872, Dr. Jamieson gives the characters in 
the Chinese language which represent certain forms of disease. The following indicates 
the translation of these characters, namely: — 1. Feng-'han, which seems to include bronchitis and 
pneumonia; 2. SMng-ch'an, child-birth; 3, Lao-ping, a convenient term covering every disease 
at the end of which the patient dies exhausted — tuberculosis and syphilitic and cancerous cachexia 
find places under it ; 4. Ohing-ping, or ' violent disease ' — another convenient and comprehensive 
term ; 5. Shang-'han, which seems to be characterized by intense heat of skin, including probably 
typhus, pneumonia, and acute tuberculosis; 6. T'u-hsieh, haemoptysis; 7. K'o-sou, or cough — 
chronic bronchitis no doubt, often supplemented by asthma ; 8. Fa-sha, which includes every 
state of insensibility; 9. Ku-chang, or 'drum dropsy,' ascites; 10. Fu-chi, choleraic diarrhoea; 



HISTOEICAL NOTICES OP MEDICINE IN CHINA, ETC. 73 

11. Hsu7i-szu, suicide ; 12. Tung-feng, acute rheum atism ; 13. Ticn-hua, small-pos; 14. Accidental 
burning.— (III. 82.) 

As examples of some at least of the modern methods of Chinese professional practice^ the 
following, which are casually alluded to in the Reports now being considered, are here given, 
namely : Surgical operations by them are for the most part comprised under the 
headings of acupuncture, application of the moxa, and the opening of abscesses. 
The two first are practised in all manner of diseases, wherever there is local pain or swelling. 
As a rule, Chinese practitioners are timid with the knife. — (XIV. 51.) In gunshot wounds in 
which the bullet lodges the means employed by Chinese surgeons consist merely of the apjDlication 
of ' a variety of plasters guaranteed to draw the bullets out.-" — (III. 51.) 

At Hoihow, October to March, 1880-81, the application used by the Chinese in cases of burns 
consists of fermented rice and cabbage-leaves. ^ — (XXI. 75.) In the Report to September of the 
same year, it is stated that ' the new Taotai who arrived at Kiungchow in April died two months 
afterwards ; his death due to exhaustion, the result of diarrhoea and hsemorrhoids.' It was stated 
that seven native doctors were called in to attend him, but were all afraid to administer any of 
their drugs, fearing that his death should happen while he was under their treatment. — (XXII. 9.) 
At Newchwang, October, 1880, to March, 1881, Dr. Watson observed that 'many Chinese 
doctors in this neighbourhood are skilful in the treatment of dislocations. On one or two 
occasions he has been sent for to see natives who had falls and dislocations, but before his 
arrival on the scene the mischief had been discovered and rectified.' — (XXI. 40.) 

At Ichangj according to the Report for the six months to September 1880, although Dr. 
McFarlane made strenuous efforts to get natives to remain in hospital, he so far failed to do so. 
They will, however, undergo any amount of pain, and drink medicine ad libitum, if allowed to go 
home immediately after it.' — (XX. 20.) Again : in his Report on Takow and Taiwan-foo, for the 
half-year ending March, 1882, Dr. Myers writes: 'Native appreciation of foreign medicine in 
South Formosa seems to be more conspicuous than in other parts of the Chinese Empire. This is 
due to the medical practice and teachings of Dr. James Maxwell, of the English Presbyterian 
Mission,' whose name is still mentioned in many parts of the island, not excluding some savage 
districts. Unfortunately there has sprung up in Formosa a horde of charlatans who — under the 
guise of having been connected with foreigners, no matter in what capacity, and therefore 
authorized to dispense Western medicine — will, if not checked, in course of time do much to destroy 
the good previously accomplished. In order to meet this state of things Dr. Myers writes: 'It 
would be a great aid towards propagating the benefits of foreign medical science if duly instructed 
natives could be sent out— that is, highly instructed in anatomy, physiology, and the higher 
departments connected with the practice of medicine.' — (XXIII. 24). 

At Swatow, 1879, the reporter was glad to notice an increasing desire among the Chinese in 
the more immediate neighbourhood of the settlement to obtain foi-eign advice. On 
many occasions children in the early stages of infantile fever, diarrhoea, and other 
affections were brought to hospital, instead of, as formerly was the case, when their condition 
had become extreme. — (XVIII. 79.) 

At Wenchow, 1877-78, the Chinese were shy of coming under treatment by English medical 
men. On the one hand, they believe that in certain cases death is no bar to -vyciiciiow 
foreign skill ; in other instances they believe more in their own physicians than in 
foreigners. — (XV. 40.) 

Although Western medicine, as a system, is by no means welcomed in China, Japan. 
like everything else foreign, it is so in Japan. — (XIX. 40.) 

10 



/4 EPITOME OF MEDICAL REPORTS. 

As yet, the diseases of Japa.n have been comparatively little studied, and the effects of the 
climate of that couutry upon the European constitution still remain imperfectly understood. 
In matters medical Japan is often confounded with the more tropical East ; on this theory 
extra premiums for life assurance are frequently charged. Hence the inquiry is important, an 
abstract of which follows, taking Yokohama as the representative locality, the years 1868 to 1877 
the period to supply the requisite data. — (XV. 48.) 

Of all patients admitted to hospital at Yokohama in the three years 1875-77, residents 
furnished 32'96 per cent. ; new residents C7'03 — many of the latter being seafaring men — hence 
for the ten years it is safe to take the admissions to represent one-third residents, and two-thirds 
non-residents. Out of the resident foreign population many had previously lived in the more 
tropical East, as India, or Southern China. — (X.V. 49.) The farther details in respect to parti- 
cular diseases in Japan, follow in their order, and supplementary to the remarks on those diseases 
as they occur in China. 



DISEASES, ETC. 

I. SMALL-POX. 



Acc'OEDiNG to a literate named Chwang, a native of Hunan, in the present dynasty, the first 
appearance of small-pox in China was in the reign known as Chien Wu, that is, about A d. 317. 
The Emperor's name at that time was Sz-ma-yen j his posthumous name is Yuen-ti, 
the first of the Eastern Tsin dynasty — a.d. 317 to 420. In a Corean medical work, 
consulted by Dr. Dudgeon, called ' Tung-i-pau-chien,' it is stated that the ancients knew nothing 
of small-pox and measles, but the writers believe that the former took its rise somewhere about the 
end of the Chow and beginning of the Tsiu dynasty ; in other words, about the year B.C. 241. But 
Dr. Dudgeon is of opinion that this position is untenable. — (III. 9.) 

In the half-year ending March, 1873, small-pox did not make its appearance at Peking as it 

had done in the few preceding winters. Vaccination is not practised among the Chinese during 

winter, and there is the greatest difl&culty in keeping up the supply of lymph durino- 

°' that season. Only one native vaccinator, a semi-official one, and of long-standing, 

who has branch establishments at Tientsin, and at Taiyuen-fu in Shansi, is able 

to keep it up. His method is to hire poor children for this purpose during the winter, who live 

in his establishment. — (VI. 11.) 

In the winter of 1873-74, small-pox, 'as usual, on the approach of cold weather, prevailed 
among the Chinese, no doubt with its ordinary results, as vaccination is not practised, owing to the 
native theory of its inadmissibility at that season.' No case of the disease occurred among the 
foreign population. — (VIII. 29.) 

In his Eeport to 31st March, 1875, Dr. Dudgeon records the death of the Emperor of China, 
barely 19 years of age, ' asserted to be from an attack of small-pox, which, as in former winters, 
has prevailed more or less extensively and epidemically.' The Emperor of China was attacked 
with 'the heavenly flowers' on 9th December — the day of tho Transit of Venus. The Chinese 



SMALL-POX, VACCINATION, INOCULATION. 75 

state that this is not the first monarch who has died, as it were, astronomically ; and they mention 
several whose death coincided with certain phenomena of the heavenly bodies. He died on 12th 
January ; and ' on his demise a memorial was presented to the throne to have the two medical 
men, court physicians, and members of the Great Medical College, who were in attendance, 
severely punished.' It is stated, however, that they were not to blame; they treated their august 
patient secundum artem, and, of course, could not deviate from the beaten track laid down in their 
ancient system. It has been stated that the Emperor had small-pox in his youth ; also, that there 
were suspicious circumstances in connection with his death. The present little child-Emperor has 
been vaccinated. It is also stated that the Emperor and Empress of Japan have been vaccinated 
since the news of the death of the ' Son of Heaven,' — (IX. 34.) 

The Chinese recognise small-pox and measles as depending upon a poison inherited from the 
parents, which resides in the system till it is developed by external exciting causes, 'like fire 
concealed in the flint.' As a prophylactic against the disease, or to render the attack slight, it is 
recommended to eat cinnabar, dried umbilical cord and placenta, hare's flesh, cobwebs, etc. ' At 
the approach of each winter, and particularly when the weather is mild, and an unhealthy spring is 
feared, when small-pox chiefly prevails, beans are to be eaten.' Beans are considered to be an 
antidote against all poisons. Independent of the supposed fatal poison, the books of the Chinese 
recognise small-pox as epidemic, ' depending, as they express it, on the air of the seasons.' They 
enumerate five kinds of the disease, corresponding to the five viscera — namely, lungs, heart, liver, 
stomach and spleen, and kidneys. They divide the duration of the disease into periods of seven 
days each; namely, of incubation, development, and decay. The condition of the pustules and 
patient, of favourable and unfavourable symptoms, are all noted. Minute directions are laid 
down for the period of convalescence, including contra-indications in regard to eating, drinking, 
avoidance of smoke and dirty water in the room, combing of the hair, the smell of wines, spirits, 
and urine, sulphur, asphyxiating medicines, and other matters. To preserve the eyes from the 
ravages of the disease, a plaster is used, encircling the eyes, the idea being to limit and prevent the 
malady from crossing over and attacking them. To prevent pitting, the oil of the seeds of the 
man-tsing are used, with which the parts are smeared, or the face is ordered to be washed with 
the water in which shellfish have been steeped. — (IX. 35.) 

During the summer of 1871, small-pox alone of the contagious fevers affected the Chinese 
population of Newchwang. The disease is never absent from that town and district. — (III. 12.) 
In the summer of 1872 a ship entered the harbour, having on board a case of small- 
pox. The vessel had come from Shanghai, all the men on board having been 
healthy at the time of sailing, although during the voyage one man was attacked with the disease 
and recovered. Subsequently a second and a third case of the disease occurred on board, but 
the patients were both removed and treated on shore. In reference to this occurrence Dr. Watson 
discusses the general subject of Quarantine. — (lY. 27.) During the year ending March, 1880, 
the natives in the town suffered slightly from small-pox, but a large trading-mart, distant from 
that port some 30 miles up the river, was visited by a severe and sadly fatal epidemic of the 
disease. — (XIX. 1.) 

In the half-year to March, 1873, two deaths by small-pox occurred among foreigners at 
Chefoo — both in January. The subjects of the disease in both instances were natives of the 
Sandwich Islands, one of whom arrived in his ship suffering from the affection, chefoo 
and is stated to have communicated it to the other. Dr. Myers writes regarding 
the comparative immunity enjoyed by Western foreigners, as being one of the highest tributes to 
the efiicacy of vaccination. — (V. 22.) 

10—2 



76 EPITOME OE MEDICAL REPORTS. 

At Chiukiang, in tlie seven montlis ending Jlai-chj 1376, small-pox was epidemic, and deafclis 
^, . , . from that disease in the city and its suburbs very numerous. In a few cases 

Chinkiang. •' . 

recorded the form of the disease was so mild as more properly to come under the 
head of varioIoid.^(XI. 2.) 

Accordiug to the Report to September, 1876, ifc was not till June of that year that the annu<il, 
epidemic, of small-pox entirely disappeared. One case only occurred among the foreign com- 
rannity. ' This was a severe one, and although the patient presented clear marks of former 
vaccination, with a history of an abortive attempt some three years ago, the case presented many 
of the grave symptoms of the confluent form.' — (XII. 27.) As usual, small-pox prevailed during 
the winter of 1876-77 ; it did not amount to an epidemic, however. Only two cases of the disease 
occurred in foreigners, namely, that of a seaman on board H.M.S. Frolic, in January, a day or two 
after the arrival of that vessel from Shanghai j a second in a man who had visited the Frolic. In 
reference to the latter, the medical officer notes that the circumstance of the subject of the attack 
having been on board that vessel surely indicates a possible source of contagion. In the treat- 
ment of cases no internal medicine was given beyond an occasional night-draught and laxative. 
A solution of carbolic acid in glycerine is applied externally, a method by which circulation of pus 
in a state of decomposition, or some product arising therefrom, is said to be prevented. — (XIV. 64.) 

In the Report for the year ending September, 1878, Dr. Piatt stated that 'small-pox, so 
constantly met with here during winter and eai-ly spring of former years, was rarely seen.' — 
(XVI. 20.) During the year ending March, 1881, the occurrence of one case only of the disease 
is recorded, and it in the month of June. — (XXI. 99.) 

At Kiukiang, during 1871, two cases of confluent small-pox, one of which proved fatal 

_. , . on the tenth day, were recorded. Twenty vaccinations were performed. — (II. 

' 66.) 

At Hankow, according to the Report for the half-year ending September, 1871, the English 
settlement is completely cut oif from the Chinese portion. Small-pox, repeatedly and severely epi- 

„ , demic, affected alike both natives and foreigners so long as the latter resided in 

Hankow. . 

the town ; since they occupied their ' settlement ' they ha.ve been free from the 

disease.- — (II. 45.) In that ended September, 187ii, an epidemic of small-pox was watched in one 

of the institutions for native children, where many were unvaccinated. But of fifteen attacked 

only one died, the disease being of a mild type. — (XII. 15.) Prom that date to September, 1877, 

only one case of confluent small-jDox occurred, and it in a foreigner residing within the limits of 

the native city. The disease was moderately prevalent in the neighbouring cities during the 

winter and spring months of 1876-77, but it was said not to be of a fatal type, nor did it exhibit 

an epidemic prevalence such as the same disease recently did in many cities in Europe. — (XIV. 79.) 

At Shanghai, 1871, there was no difficulty in protecting the foreign population from small- 

joox by means of vaccination and re-vaccination. The Chinese do not object to vaccination, but 

siiangliai. they have been accustomed to inoculation; and confluent small-pox so seldom 

Vaccination. foUows the usual Operation, that they see no great reason to change their system. 

Inoculation. They would as soon have their children vaccinated, but they do not much care. 

Por some years a vaccination establishment existed, the applicants to which have lately increased 

in number ; as, however, the small-pox season is considered to end with April, the attendance fell 

off after that date. — (11.35.) Vaccination was constantly performed during the winter months 

of 1871-72. There was no fatal case of small-pox among foreigners in the settlement throughout 

that period, and only two cases of the disease reported, both benign. Inoculation is, however, still 

practised by the Chinese. — (III. 79.) 



SMALL-POX, -VACCINATION, INOCULATION. 7 7 

According to the Report^ A.pril to SeptemLer, 1872, small-pox disappeared in April, two cases 
only having occurred in that month, both in the police force. Variola is never absent from the 
native quarters, andit is stated will not be so until stringent measures are adopted for the preven- 
tion of inoculation, The vaccination dispensaries are month by month becoming more crowded, 
but the impression they make upon the vast number of children demanding protection from small- 
pox is very slight. — (IV. 100.) 

In the half-year, October, 1874, to March, 1875, small-poxwas'very prevalent among the Chinese, 
but only two cases were reported among foreigners. Partly on account of its prevalence, and 
partly on account of the death of the Emperor by that disease, vaccination was eagerly sought 
by the Chinese, and 400 of their children were accordingly vaccinated at the Municipal depot 
during the first three months of 1875. — (IX. 7.) The disease was present throughout the half- 
year April to September, 1875. — (X. 55.) In that to March, 1876, small-pox was not epidemic. 
One case, which occurred in a tidewaiter, was remarkable for the fact that the patient had 
had the disease twice before, and bore three good vaccination marks on his arm. — (XI. 50.) 

In the Report to March, 1878, Dr. Jamieson writes : ' Of all diseases, small-pox would seem 
to be that one which should be most easily diagnosed.' That mistakes are possible appears from 
the following case : On the 8th of February, an oflBcer of the Kiva-sing complained of ague. Up 
to the 6th he had been well. On that day he had a short attack of shivering, followed by 
perspiration, for which, looking upon it as ague, he took quinine. On the third day these 
phenomena were repeated. Eighty hours after the first manifestation of fever, the characteristic 
eruption appeared. This patient had been re-vaccinated three years previously on board an 
English man-of-war, but without result. It is recorded that in the year 1877, at this place, 1,98 i 
native children were successfully vaccinated at the G-atzlaff Hospital, and 3,833 more in the 
Taotai's establishment in the city, making in all nearly 7,000 children thus protected during this 
year and that preceding. The first case of small-pox for the season occurred on the 8th December. 
Others were admitted on 9th December, 3rd January, and 8th February. All terminated favour- 
ably.— (XV. 9-16.) 

During the year 1878, the vaccinations performed at the Municipal establishment for the 
purpose numbered 1,295; at the GutzlafE Hospital, 1,537; making in all 2,832, or in round 
numbers, and allowing for vaccinations performed by natives from lymph obtained 
from the foreign establishments, 3,000. Whatever objections to vaccination the 
Chinese may once have had are no doubt melting away ; but a serious objection to the vaccina- 
tion of girls lies in the fact that, without a few marks as evidence of having passed through 
small-pox, a marriageable maiden is wanting in one of her chief qualifications, natives in search 
of wives not having yet learned to accept the vaccination scar as a promise of future immunity. 
One solitary case of small-pox occurred in the foreign community. During the months of 
February and March an epidemic of chicken-pox 'rushed through ■" the settlements, 
children being chiefly affected. — (XVII. 18.) In the six months ending March, °^°^' 

1880, there was no fatal case of small-pox. A.t the Shantung Road Hospital, in 1879, the total 
number of vaccinations performed was 5,129. At the Gutzlaff Hospital 1,859 children 
were successfully vaccinated, and about 150 tubes were distributed to natives for 
use in the country. — (XIX. 19.) In 1880, small-pox was prevalent among the shipping as late as 
the month of May, and cases occurred from time to time throughout the year ending September. 
The entire number of oases reached its maximum in April. In the entire winter of 1880 small- 
pox caused only one death. — (XX. 33.) On board ship, according to Dr. Burge, the cases of 
that disease met with are either imported from Japan, or contracted by the sailors when visiting 



7S EPITOME OF MKDICAL REPORTS. 

the back slums of Shanghai. During 1880 there were vaccinated at the Anglo-Aroerican 
Dispensary, 1,472 chiklren ; at the French Dispensary, 1,232 j and at the Gutzlaff Hospital, 
1,481. In reference to the latter, Dr. Jamieson states that not more than half the children 
vaccinated are brought back for inspection. Of this half, a number, varying from one-eighth to 
one-sixth, have not taken at all. Of the remainder, a very considerable ratio have had the vesicles 
broken by accident or carelessness, or covered with native medicine. Thus a bare record of 
vaccinations performed is quite misleading as an indication of the real value of the work done. 
Yet Dr. Jamieson writes that he has never seen small-pox in a vaccinated European child at 
Shanghai.— (XXI. 83-97.) 

At Wenchow, according to the Keport for the six months to March, 1878, small-pox did 

not seem to be more rife than the fact of vaccination not being practised would lead one to 

expect. — (XV. 40.) In the Eeport for the six months April to September, 1881^ 

„ , . Dr. Macgowan wrote : ' Vaccination is making considerable progress in many 

Vaccination. ° ..,_.-.,, 

provinces. Physicians who make a speciality of infantile diseases often include 
vaccination in their practice ; there are also persons who make it their sole occupation. Dr. 
Macgowan adds : ' The extension of this great improvement cannot; be viewed with unmixed 
satisfaction.' It is to be feared that ignorance or dishonesty on the part of vaccinators may 
delude whole communities by spurious operations, the baneful consequences of which will 
become apparent when a small-pox epidemic of unusual virulence ajDpears. At Kinhua, vaccina- 
tion has been taken up by the Buddhist priesthood ; and as they surround the act with mystery 
and imposing ceremonies they are likely to monopolize the new vocation. A'native Christian 
vaccinator who would not thus deceive the people has lost his practice, and has been obliged to adopt 
another calling. Vaccination will not speedily supersede inoculation, which, since its introduction 
, . from Thibet, a.d. 1023-56, has served to mitigate the violence of small-pox, 

Inoculation. ■ t n ■ c t-t t ^ 

introduced m the first century from the then foreign region or Hupeh by the army 
of the hero Ma Yiian.'— (XXII. 46.) 

At Poochow, in the half-year to September, 1871, three cases of small-pox were recorded. They 
were mild varioloid, and required no treatment. They occurred in well-vaccinated subjects 
belonging to one of her Majesty's vessels, and the disease was clearly traced to 
a native bazaar where the men had enjoyed their leave on shore. There has 
been nothing that can be called an epidemic of variola among the foreign community at this 
anchorage, although cases occasionally occur among them. Small-pox, however, is epidemic 
among the Chinese in the spring, and sometimes also in the winter months. — (II. 27.) In the 
Report to September, 1877, a translation is given of a document that was posted on the walls in that 
neighbourhood. The purport of the translation in question is as follows, viz. : ' Vaccination was in- 
troduced hither from Europe. It is practised by " planting three seeds " of virus in a spot on the 
left and right arms above the elbows. This spot is called " the cold-dispelling pool," and upon it is 
formed the virus, and a scab, there being no eruption upon the body generally. The result is 
effected in ten days, and no failure can possibly take place, whilst security is obtained from any 
natural and original attack of small-pox, or from a second attack^ if the patient has already had 
it,' etc.— (XIV. 89, 90.) 

The following remarks similarly represent the opinions held by the Chinese on the subject of 

inoculation^ namely : ' Inoculation has been practised in China for some hundreds of years. 

The Chinese call small-pox " Heaven's flowers," and inoculation " Cultivatino- 

Heaven's flowers.'' ' The mode of procedure in inoculation is to pulverize the scabs 

taken from a small-pox patient, and blow the powder thus obtained up the nostril of the child. 



SMALL-POX, VACCINATION, INOCULATION. T'J 

They inject the powder into the left nostril in the case of a boy, and into the right in a girl. It 
IS impossible to tell whether the disease thus introduced will be severe or not. In some years 
there are few if any deaths, at other times the mortality is much the same as that from small-pox. 
Another method is to put the clothing of a patient suffering from small-pox upon tbe child. 
They always take the matter from a mild case of the disease. They are careful to choose a lucky 
day for the operation, and a time when the child is in good health. They prefer to induce the 
disease at an early age, as in this way they are able to prevent the child from scratching the 
pustules and so causing pitting.' 

It is stated that in China vaccination is steadily gaining way; tbat inoculation is losing way. Dr. 
Ringer has it from reliable native sources that inoculation is not very much practised, and that the 
suspicion with which vaccination was formerly regarded as a subtle device of the wily 

f.. ... ,-r->/-^ TIT 1 ... .. -, Vaccination. 

loreigner is dying out. Dr. Osgood believes that vaccination is gaming ground every 
year, and is destined in time to drive out inoculation. In Foochow and its neighbourhood it is the 
rule to vaccinate, and he is of opinion that there must be at least from twenty to thirty natives en- 
gaged in the work at this port. According to the Report from April, 1880, to March, 1881, vaccina- 
tion had made but slow progress. Annually during winter small-pox visits almost all those who 
have not been protected by inoculation, or by a previous attack of the disease. According to the 
Report quoted, two cases of modified small-pox occurred (among foreigners), both traceable to an 
amah who had visited her relatives while they were suffering from the disease. With small-pox 
annually in the neighbourhood it seems difficult to avoid infection. All ought to be vaccinated 
and re-vaccinated, and the suggestion is made that families ought to refuse leave to their servants 
during the period from January to May, when small-pox, measles, and parotitis are so common 
among natives. — (XXI. 62.) 

At Amoy, in 1871, Drs. Miiller and Manson wrote that with the exception of small-pox they 
had there met with no representative of the class of continued fevers which claims so large a 
number of victims in Europe. They observe that small-pox is very prevalent j 
every person is sure sooner or later to contract the disease. This is not matter of 
surprise, vaccination being unknown. Mortality from the unmodified form is about one in three. — 
(II. 11.) In the half-year to March 1873, from the middle of January, small-pox was unusually 
rife. The disease was of a very mild type ; the mortality by it not more than one in twenty 
cases. On account of this benignity of type the native inoculators have been very busy, and 
have probably done much to spread the disease, Seven foreigners were attacked, four of the 
shore-going and three of the floating population. All the cases ran a very mild course, being 
much modified by previous vaccination. — (V. 8.) In his Report to September, 1873, Dr. Manson 
notices the circumstance that small-pox, like syphilis, when attacking races for the first time, is 
characterized by a virulence and deadliness seldom met with in their subsequent histoiy. ' Those 
liable to the worst forms are killed off, and only those whose systems can survive, or can acquire 
a less deadly form, remain to propagate the next generation with its constitution of greater 
strength or less susceptibility. An extension of the same principle will help to explain the 
decay of epidemics, or the complete extinction of some diseases.'— (VI. 31.) In the six months 
to March, 1878, small-pox, ' usually so prevalent in the spring,' hardly showed itself. — (XV. 25.) 
During the winter of 1878-79, the seasonal epidemic of the disease was unusually extensive. It 
was, however, of mild type, and all the foreigners attacked, nine in number, recovered. ' It is 
interesting to watch the regularity with which this annual epidemic occurs.' Among the circum- 
stances to which this recurrence is assigned are the following, viz. : 1. Winter is the season 
selected to practise inoculation. [Is this not because then small-pox is more readily induced than 



80 EPITOME OF MEDICAL REPOKTS. 

at other periods of the year ?] 2. At this season the poor redeem their clothes from the pawn- 
shops. 3. The crowding and dirt incidental to cold weather. — (XVIII. 58.) 

But by far the most potent cause of the winter prevalence of small-pox is believed to be the 
practice of inoculation. This operation is performed in two ways. The most usual is the intro- 
duction of powdered small-pox pustule-crust into the nostril of a child as 
already noticed. Another equally efficacious method^ but only in vogue among 
the wealthy^ is the employment as wet-nurse of a woman who has nursed a child with small-pox- 
Very high wages are paid to those who lend themselves out for this purpose; paid, however^ only 
on the recovery after successfal inoculation of the child. — (XVIII. 59.) In the half-year ending 
March, 188U, ''the usual spring epidemic of small-pox passed over very lightly.' — (XIX. 30.) 
In that to March, 1881, the spring epidemic was not particularly virulent or widespread among 
the natives, and only one foreigner was attacked. — (XXI. 57.) 

At Kelung, in the half-year to March, 1877, one- case of small-pox was noted. The patient 
Tamsui mi Contracted the disease in the country, and after passing through the usual stages 

1= "°g- finally recovered with very slight pitting. — (XIII. 7.) 
In the Report on Takow and Taiwan-foo, to 31st March, 1873, it is stated that small-pox 
was very prevalent on the coast of Formosa, and also among the aborigines in the inland parts 
Taiwain and of the central and eastern parts of the island. A considerable number of persons 
Takow. QQ (.jjg island have been vaccinated. It is also stated that on the occurrence of a 
case of small-pox among the natives of that island, the custom is for the friends and relatives 
of the patient to desert the infected house, leaving at the bedside of the sufferer sufficient food 
and water to last during the natural course of the disease. Sometimes the entire population of 
a village will decamp at ouce on the occurrence of a case. — (V. 27.) According to the Report 
to September, 1873, small-pox appeared about the beginning of March, 1873, and was very 
prevalent during the summer months. According to the natives the epidemic appeared earlier 
than usual, and was of an unusually fatal character. An immense number of the younger natives 
of the towns and of South Formosa were carried off by it. Only seven cases came under the 
notice of Dr. Rennie, and of these five died^ the disease being confluent in all. — (Yl. -lu.) In the 
six months ending March, 1876, one case occurred in port. The disease, never absent from the 
island, was, at the beginning of the year, very prevalent about Taiwan-foo ; but, as yet, few 
cases had appeared near Takow. — (XI. 21, 20.) According to the Report to March, 1877, small- 
pox, as formerly, was prevalent during the spring months, ' but before many years the disease 
must become greatly modified by vaccination, which the natives most enthusiastically run after.' 
Vaccination ^^ Connection with the hospital estabhshed there, five vaccinators were busily 
engaged in the surrounding districts.— (XIII. 42.) In spring of 1878, small-pox 
'made its annual appearance' among the natives. — (XV. 37.) According to the Report for 
the half-year ending March, 1882, vaccination is eagerly sought after. But, unfortunately, 
some so-called vaccinators are only armed ' with capillary tubes which they fill with any fluid 
from dirty water up to pus.' Through this, ' a condition of incredulity is being set up ; and 
what is worse, even loss of life has followed the practice. At a village not far from this place 
a great number of children are reported to have died after inoculation with a fluid which has 

been styled vaccine lymph, and this event has naturally caused some little sensation.' 

(XXIII. 23.) 

At Swatow, in the half-year to September, 1871, only one case of small-pox occurred amon 
Swatow. foreigners, and it imported from Shanghai. — (II. 9.) In that to September, 18 
only two cases of that disease. — (IV. 88.) In winter of 1870-77, an epidemic of small-pox was 



72, 



SMALL-POX, VACCINATION, INOCULATION. 81 

said to prevail among the Chinese in and around the settlement. Many of the natives ap- 
plied to Dr. Scott for vaccine lymph, and it is stated that in the district vaccination is 
extensively practised. — (XIII. 9.) During the six months ending September, 1881, 
an epidemic of varicella occurred among the resident children on Double Island, 
seven of whom were attacked. The eruption was copious, constitutional disturbance very slight, 
and all the patients recovered. — (XXII. 4.) 

At Canton an epidemic of small-pox broke out towards the end of 1870, continued in the city 
and neighbourhood during the spring season, and extended to several distant districts, including 
Hiang-shan. Its violence was less in degree than the previous epidemic some 
years before ; its mortality 20 to 30 per cent, among the unvaccinated, and very 
inconsiderable among the vaccinated. There are fifty to sixty professional vaccinators in Canton, and 
about one-half the children in the city are now vaccinated. Only one foreigner took the disease. 
— (III. 70.) During the half-year from April to September, 1872, there was no epidemic of 
small-pox, but scattered cases of the disease appeared up to the month of May. In one case the 
face was smeared over, first with strong, then weak solution of nitrate of silver, then mercurial oint- 
ment and powdered starch ; but pitting occurred notwithstanding. — (IV. 69.) In the Eeport 
for the six months ending September, 1877, the statement occurs that small-pox, which was 
severe in the city last winter, was still prevalent up to the middle of April. — (XIV. 58.) 

From October, 1877, to March, 1878, there was no epidemic of small-pox. According to the 
Eeport by Dr. Wong, ' The Cantonese of that date had a high appreciation of vaccination.' 
That process appears to have been first introduced among them in 1805 ; and, in reference to this 
circumstance, an interesting letter from Sir John Barrow to Dr. Jenner is given at page 14 of the 
fifteenth issue of the Reports now being analyzed. To Dr. Pearson, of the B.I.O., who laboured 
at Canton from 1805 to 1820, is due the credit of introducing the practice of vaccination here. 
It was not, however, until within the fifteen years preceding 1878 that it has obtained general 
acceptance among all classes ; but at the latter date it was considered that 95 per cent, of the chil- 
dren in the city had undergone it. It was always the custom to vaccinate direct from the arm, but of 
late years many Chinese vaccinators have been taught by Dr. Kerr to preserve the lymph in 
tubes. Chinese mothers object to have lymph taken from the arms of their children, under the 
idea that it weakens their constitution. The general age at which children are vaccinated is two 
years; some, however^ undergo the operation at four or five months. — (XV. 14.) During the 
spring months of 1879, small-pox of a confluent form was very prevalent among the Chinese. 
Two villages on the island of Honan, opposite Canton city, were almost depopulated by it. — 
(XVIII. 56.) In the six months ending March, 1881, an epidemic of small-pox prevailed, as 
also in the districts west and north of that city. Among the Chinese the disease raged to an 
unprecedented extent, and with great mortality. Among the foreign residents vaccination was 
generally adopted; five cases only occurred, of mild type, and without a death, — (XXI. 71.) 

At HoihoWj during the half-year ending 31st March, 1881, small-pox was very much dreaded. 
Five years previous to that date there occurred an epidemic of the disease, in which 600 or 700 
lives are said to have been lost in that town and neighbourhood. Dr. Aldridge 
writes: 'The Chinese have great faith in vaccination.^ At the end of 1877, the 
officials invited a Chinese vaccinator in Hong Kong to come here, which he did, and vaccinated 
800 persons. During the last months of 1878 and early months of 1879, there were 8,500 vacci- 
nated; in the same period of 1879-80, there were 1,200 vaccinated; and since October, 1880, to 
the date of theEeport now quoted from, 4,000 children and adults have been vaccinated. — (XXI. 75.) 
In November, 1881, a Chinese vaccinator from Hong Kong again arrived, and vaccinated 300 

11 



82 EPITOME OF MEDICAL REPORTS. 

persons. He tlien left for Pakhoi. Since his departure^ six petty officials have been sent by the 

Viceroy to perform vaccination among the native population of the island of Hainan. — (XXII. 31.) 

As regards Japan, in one year only in the ten-yearly period from 1868 to 1877, namely m 

1869, were there no admissions for small-pox ; but 1872, 1873, and 1876 were practically also years 

of exemption, as the oases of non-residents in each of those periods had been acquired 

^^ °' elsewhere — for the most part in China. During the winters respectively of 1870 and 

1871, a severe epidemic of this disease prevailed; in the former, the rate of mortality thereby 

was 26--4 per cent, of those attacked; of the latter, 21-8. In 1874-75, the disease was again 

epidemic, but less extensive, and in type milder than on the former occasion ; the death-rate 19'6 

per cent. The above figures refer to natives. Many of those attacked were broken down in 

health by previous disease or dissipation. Already had the action of Government in reference to 

public vaccination done much to control the spread of small-pox, and still more in this direction 

was looked for in the future. — (XV. 50.) 



II. MEASLES. 

In the Report to September, 1872, Dr. Dadgeon observed that in the spring of each year there 
was always more or less measles present in that capital. In the spring of 1866, 
an epidemic of this nature occurred. A similar epidemic was reported from the 
mouth of the Amoor. — (IV. 41.) 

At Newchwang, in April, 1872, a child, aged three months, residing in the Custom House, 
became sharply attacked with measles. The lungs were inflamed for two days, but there occurred 
no other complication. No other case of this disease occurred ; although, as observed, 
ten other foreign and two Chinese children were living at the same time in the 
block of buildings that constitute the Customs' premises. Isolation of the affected infant is con- 
sidered to have ensured this exemption on the part of the other occupants. — (IV. 27.) According to 
the Report for the two years ending 30th September, 1876, a case of measles occurred in a healthily 
situated house near the settlement; its origin was traced to contagion from a servant who had several 
members of her family ill of that disease. Measles is very common among the Chinese, but this 
was the only case in the foreign community. — (XII. 29.) According to the Report for the year to 
March, 1881, thirteen cases of measles occurred in that period in six European families ; namely, 
two in adults, the remaining number in children of ages varying from one month to eight years. 
Recovery took place in all. — (XXI. 38.) 

At Chefoo during the half-year ending 31st March, 1880, a mild case of measles occurred 
in a young child. Many children in the adjoining villages were attacked with this affection, 
and also suffered from an invasion of whooping-cough, illustrating the relation 
which exists between these affections, one sometimes preceding the other, sometimes 
following. After the epidemic of measles had subsided many of the natives were attacked with 
inflammatory sore throat, in some instances attended by exudation of false membrane, simulating 
diphtheria, the temperature (of the skin) reaching 103° or 104°. Some of the families thus attacked 
lost two or three of their members. — (XIX. 32.) 

At Hankow, during the spring of 1876, a few cases of rbtlieln occurred, but the 
disease did not become epidemic. The persons affected were attacked suddenly ; a 
measly eruption appeared in the course of the first day, and continued visible for 
a few days. — (XII. 15.) 



MEASLES, ETC. 83 

At Shanghai, during September and October, 1871, an 'ephemeral exanthem' of the nature 
of measles affected large numbers of foreigners and natives; adults and children alike its 
subjects. (See ' Pung-sha/)— (II. 41.) According to the Eeport to March, 1872, 
measles, together -with diphtheria, croup, scarlet fever, laryngitis and many other ^'°^ *"■ 

diseases common enough, and very fatal in England, especially among children, are unrepre- 
sented at Shanghai. — (III. 86.) During the six months ending March, 1873, an epidemic of 
measles occurred among the children in the Eurasian school ; thirteen out of the sixteen 
children in that establishment being attacked. The disease differed ia few respects from the 
same as it appears in Europe, and in no case was fatal. Nor did the attack leave behind it any 
sequelae. In March and April several cases of the same disease occurred in private practice among 
foreign children. In neither instance was the malady observed the so-called ' Chinese measles.' 
In every case there was marked fever with catarrhal inflammation of the ocular and respiratory 
mucous membranes. On the fourth day the characteristic eruption appeared with rather an in- 
crease of pyrexia, and by the ninth or tenth day convalescence was established. Measles of this 
type is of fair average severity, and differs in no respect from the disease as seen in Europe. — 
(V. 55.) In the six months to September, 1875, some cases of the disease, very mild in character, 
occurred, but not in epidemic form. — (X. 55.) Towards the end of the half-year to March, 1876, an 
epidemic of measles prevailed. The cases were generally severe, although none proved fatal. 
Slight catarrhal ophthalmia persisted in some instances for several weeks. — (XI. 50.) The 
epidemic disappeared during the last week of June. — (XTI. 3.) 

In the six months ending September, 1880, several cases of measles were observed, but 
the disease did not become epidemic. A fatal case of it occurred in. an adult, the form of the 
affection in that instance being the hsemorrhagic or malignant. According to the Eeport under 
reference, measles in Shanghai does not conform to the English type. In several cases among 
foreign children the eruption was precocious or tardy in appearance, frequently presenting itself 
on the wrists and chest before appearing on the forehead, fugitive in character, vanishing once and 
sometimes twice for twenty-four hours at a time, and then reappearing, lasting occasionally to the 
tenth day, and generally followed by branny desquamation. In other respects there was little or no 
difference to be remarked. — (XX. 33.) Related in point of time to each epidemic of measles has 
been an epidemic of whooping-cough. In four cases during the period from October, 1880, to 
March, 1881, measles immediately followed on whooping-cough, and in five cases immediately pre- 
ceded it. When the disease has been present among the families of foreign residents it has also 
been prevalent among native childen in the settlement. The Chinese form of the disease does 
not protect against measles when a child returns to Europe ; nor does English measles (always) 
protect against it ; nor, finally, does it protect against a second attack of the same form. There is 
seldom any regularity in the shape of the patches of eruption. It may so happen that no more 
is found than a mottling of the skin of the face ; but the fever, slight or severe, the conjunctivitis, 
throat congestion, and appearance of vesicles on the soft palate and pillars, leave no doubt as 
to the diagnosis. Measles in the host disagrees with lumbricoid intestinal worms. In five of Dr. 
Jamieson's cases during the present period, the worms were expelled during the attack of measles. 
—(XXI. 95, 97.) 

At Foochow, in the period from April to September, 1872, a case of measles was imported 
from Shanghai. The patient was isolated, and the disease spread no further 
— not even to other patients in hospital. — (XV. 58.) In the half-year to March, 
1881, the occurrence of measles is noticed as an epidemic among the Chinese. — (XXI. 50.) 

At Amoy, in the Report for the six months ending September, 1871, the absence of measles 

11—2 



84 EPITOME OP MEDICAL KEPOBTS. 

up to that date was mentioned. — (II, 11.) In the Eeport to Maroh^ 1881, the statement occurs 
that several cases of extensive pneumonia following measles among the Chinese 
were observed during February and March of that year. Though measles was 

epidemic in the native town^ foreign children escaped. — (XXI. 67.) 

At OantoDj in the period from April to September, 1871, a considerable prevalence of measles 

occurred about the same time as an epidemic of small-pox. — (II. 70.) According to the Report 

„ to September, 1873, measles were more than usually prevalent, many cases having 

occurred in June. Nine foreign children suffered from the disease, of whom one 

died. Among Chinese children the sequelae are usually diarrhoea, debility, and ophthalmia j 

very rarely affections of the lungs and trachea.— (VI. 48.) In the Report to March, 1878, the 

circumstance is noticed that there was ''no epidemic of small-pox or measles.' — (XV. 14.) In 

that to March, 1880, that five cases of measles were treated, namely three, in adults and two in 

children.— (XIX. 16.) 

In Japan, among the native Japanese, measles have at times been severely epidemic ; the 

resulting mortality 'immense ' — not so much, it is believed, owing to the virulent type of the malady, 
as to the enormous number affected, amounting in one epidemic to nearly one half of 
the entire population. Foreigners also have suffered from the disease, but to a very 

slight degree, both as regards numerical extent and severity of the disease. — (XV. 50.) 



II a. FUNG-SHA, OE ' WIND MEASLES.' 

The ' ephemeral exanthem' which affected many persons in Shanghai in September and October, 
1871 (see ante, p. 83), is thus described in the Report to the former named date : ' It had previously 
been unknown among foreigners, but the Chinese professed to recognise it as Fung-sha, or " wind- 
measles.'' The length of the period of incubation would seem to be not less than four days. 
The period of invasion was marked by headache, pains in the back and limbs, nausea and general 
'malaise, but without any notable rise in the temperature. There was no catarrh. On the third 
day the eruption appeared all over the body, frequently attended with intense tingling. It was 
papular, and all but undistinguishable from measles, except in the want of configuration in the 
patches. On the third day it began to fade, and continued to disappear until the fifth day, when 
a furfuraceous desquamation set in. On the third day, however, more or less swelling of the 
palms of the hands and soles of the feet was observed, but there was no affection of the small 
joints, and no marked exacerbation following a period of remission. Fung-sha is thus distinguish- 
able from rheumatic scarlatina or dengue, while the absence of throat symptoms separates it 
from rubeola. Convalescence was generally complete in a day or two after the disappearance of 
the eruption, but in two or three instances among foreigners it was prolonged.' Dr. Jamieson 
quotes from an article by Dr. Dunlop of St. Helier's, published in the Lancet, September 30th, 1871, 
page 464, in which a somewhat similar epidemic is described as occurring in Jersey during the 
spring and summer of that year. — (II. 41.) 

In reference to the above remark, a foot-note occurs in the Report to September, 1872, to the 
effect that Fung-sha was supposed to be identical with dengue, or closely allied to that disease. 
This opinion was not shared by the majority of the Shanghai practitioners, but its existence 
probably accounts for the note in the Lancet, — (IV. 12.) 



SCARLET PEVEB. 85 



III. SCARLET FEVEE. 

In the Report on Peking from Octoberj 1874^ to March^ 1875, Dr. Dudgeon states that scarlet 
fever is a rare disease in China. It is frequently mixed up with measles. In fact, 
nearly all the exanthemata are designated by a combination of two words Ghm-fze 
and Bha-tze. The former is the word for measles (rubeola)^ the latter applied more correctly to 
scarlatina. — (IX. 40.) 

At Newchwang, according to the Report to September, 1876, scarlet fever visited the foreign 
community, there being at least one case of that disease among them, while among the Chinese 
community it is far from rare. Dr. Watson records three cases of the disease at 
that port. Two of these cases were in young girls, sisters, and they both had ^"''' '^*°^' 
severe attacks ; both made a good recovery. The house in which they lived, like so many others at 
this place, had the floor only a few inches above ground. The other instance was so slight that, but 
for those stated, it might have been overlooked altogether. — (XII. 28, 29.) In his Report to 
March, 1881, he states that it is not common in the north of China. In the winter of 1880-81, 
at Newchwang, two children, sisters, aged respectively two and four years, had very sharp attacks 
of the disease. Both recovered. The nurse who attended the children had a severe attack of 
quinsey, with malignant ulceration of the tonsils, but no other indication of scarlatina. 
—(XXI. 88.) 

According to the Report on Chefoo for the six months ending March, 1874, although 
China is alleged to have an immunity from scarlatina, this is probably merely an inference from the 
fact that this disease has not hitherto been observed. Such negative evidence 

, . .„ . . . . „ , ^ . , Chefoo. 

scarcely justifies us in assuming its non-existence, especially when we consider the 
few opportunities enjoyed by foreign physicians for a careful study of the disease among the native 
population. Details of a fatal case of the disease occurring in a child one year old are then 
given, the case apparently a solitary one. — (VII. 19.) During the winter of 1875-76, a case of 
scarlatina occurred on board H.M.S. Kestrel at Chefoo, and the reporter says ' it is interesting 
from the fact that this fever appears to be such a rare malady in this part of China.' — (XII. 43.) 
In the list of diseases noted as having occurred at this settlement during the six months to 
September, 1879, two cases of scarlatina are included. — (XVIII. 71.) 

■ In the period from October, 1872, to March, 1873, Dr. Jamieson had never seen scarlet fever 
in China. — (V. 56.) On the 23rd of October of the latter year, the first case of that disease ever 
observed in Shanghai occurred and proved fatal in twelve hours after the true nature 

. . . y-, Shanghai. 

of the malady had declared itself. The patient was a child brought from Chefoo during 
the stage of incubation. The subject was isolated, and the disease did not spread. The form of the 
attack was malignant. — (VII. 34.) In the period ending March, 1882, a case of pneumonia, 
secondary to scarlatina, occurred in the person of a (foreign ?) lady. With reference to it. Dr. 
Jamieson wrote : ' The rarity of this fever in Shanghai makes its occurrence worthy of special 
notice. Dr. Pichon and himself were satisfied as to the nature of the affection ; and sufiicient 
proof was afforded by the fact that six children in the house took the disease in turn, all present- 
ing in varying degrees the classical symptoms.'' — (XXIII. 43.) 

According to the Report on Ningpo for the year ending March, 1874, the missionaries assured 
Dr. Mackenzie that during the months of December and January an epidemic of scarlatina and 
measles of a virulent type raged among the Chinese in the city, and that many of 
the ill-fed and closely packed natives fell victims. A little later on, some foreigners 
were attacked, but recovery took place in all instances. Among the latter, Dr. Mackenzie only 



86 EPITOME OF MEDICAL KEPOKTS. 

saw one case of measles and two of scarlatina.~(VII. 24.) At Amoy, in tlie report for 
the half-year to September, 1871, Drs. Miiller and Manson state that they had 
"■''' never met with a case of scarlet fever, either at that place or on the island of 
Formosa. — (II. 11). 

If the disease scarlet fever exists in Japan, it had not up to date appeared among foreign 
residents in anything approaching epidemic form. In 1868 one case under this heading, and in 
1870 another, was admitted, both recovering. Two other cases are noticed; but 
Japan. ^^^^ ^^ ^^^^^ considered doubtful as to their actual nature ; in fact, if not entirely 
unknown among natives of Japan, it is exceedingly rare. It has indeed been stated that, subse- 
quent to the above dates, nine cases of unequivocal scarlet fever, one of which was fatal, occurred 
among Japanese at Tokio, the subjects of diiferent ages, from fifteen to twenty-five. — (XV. 51.) 



IV. DENGTJE. 

At Shanghai, April to September, 1872, dengue was not observed, although the disease prevailed 
extensively at Amoy in August and September. This absence of it is believed to be 
accounted for by the infrequency of direct and rapid communication between those 
places.— (IV. 96.) 

At Amoy, April to September, 1872, dengue appeared early in the month of August, 1872, 
and extended over many parts of the Chinese town, the disease, although not fatal, attacking 
whole families at a time. In some cases of the malady the distinctive eruption 
™°^' was present, in others it was not. According to a native doctor of the place, the 
affection was only a form of measles. He said that everyone is liable to three attacks of measles 
during his lifetime ; twice before he has the small-pox, and once afterwards. At first, therefore, 
the dengue received the name of Tclioot-jAa , or measles; Tchoot-pan, a name loosely applied 
to many febrile diseases with an eruption, or Song-pia, wind-measles. Gradually, however, it 
was considered something new, and was variously called Sin-Mii, the new disease; Siklii, the 
seasonal epidemic ; Rong-khi, the rheumatic disease, and by a variety of other loose and indefinite 
appellations. It was admitted that no one of the existing generation had ever seen the same 
disease before the present occasion. Europeans as well as natives were attacked, those afloat as 
well as those on shore. On the 1st of September, however, the disease had reached its climax, 
and from that date it gradually declined. For several weeks it was confined to the 
town of Amoy and its suburbs ; it afterwards prevailed with similar severity in all the neigh- 
bouring towns. An opinion is expressed, but confessedly without facts to support it, that the 
disease was imported by returning emigrants from the Straits Settlements, where it had been 
prevailing for many months. — (IV. 11.) 

In reference to the epidemic just mentioned, the reporter enters into some particulars regard- 
ing the history of the disease itself. The eruption of the fever may be preceded by a few hours 
of malaise, or it may begin suddenly. When fully developed, the patient is completely prostrated, 
his pulse 120 or more, temperature 103° Fahr. to 105° Fahr. ; the condition of high fever in the 
majority of instances ends abruptly about the second day, passing away with diaphoresis, diarrhoea, 
diuresis, or epistaxis ; the first of these being most common among Europeans, the two last among 
the native Chinese. There is usually a return of the fever on the fifth to the seventh day, and at 
the same time the characteristic eruption of the disease appears, after which, at the expiration of two 
or three days, the eruption begins to desquamate, fading taking place in the order as regards parts 



DENGUE. 87 

and dates of its appearance. Occasionally, witH the characteristic eruption well-marked urticaria 
takes place. The only sequelae of the disease observed, besides debility and pains, were enlarge- 
ment of the lymphatic glands, transient febrile attacks, oedema of the ankles and feet, and sleep- 
lessness. 

The treatment employed consisted of a mild aperient at the onset of the attack; during 
pyrexia small doses of nitric ether and acetate of ammonia ; subsequently small doses of quinine 
and iron. Warm baths, light food, and confinement to bed were the subsidiary measures 
recommended. — (IV. 12.) 

The following remarks occur in the Report to 31st March, 1873, namely : ' By the end of 
September, 1872, nearly all the population in and around that city had passed though an attack 
of dengue. In October very few cases occurred, and of them only two among foreigners. One 
case was met with on the 8th of November, and another on the 12th, and those were the last 
observed. During the winter, sequelae of this disease presented themselves, chiefly in the form 
of severe and persistent rheumatic pains, benefited by faradization. Other sequelae were impair- 
ment of sight, dyspepsia, rheumatism, and paralysis of certain groups of muscles. — (V. 7.) 

During the half-year ending 31st March, 1878, it was recorded that dengue made its 
appearance in Formosa, at Taiwan-foo, on 5th October, 1872, and within a few weeks almost the 
entire population of the capital had undergone this disease. It was believed 
that the epidemic was introduced by the Mary, a vessel which arrived at Taiwan- TahfaLSio 
foo from Amoy about that date ; and from which several native passengers, suffering 
from the disease, landed and took up their residence in the suburbs, in which locality the 
disease first broke out. At Takow, a village 25 miles to the southward of Taiwan-foo, the 
disease was at no time very prevalent, only a few cases occurring among the Chinese. In the 
country districts the ratio of persons attacked was much smaller than in the capital. At Taiwan- 
foo two foreigners suffered from the disease. At Takow no foreigner was attacked. — (V. 26.) 

Dengue, occasionally epidemic in China, has not hitherto appeared as such in Japan. One 
case, and it of mild type, in the person of a foreigner, has been recorded at Yokohama Japan. 
up to 1877.— (XV. 52.) 



V. — CONTINUED FEVEES, ETC. 

At Peking, in 1868, a severe epidemic of typhus fever occurred. Typhus, like small-pox, is 
hardly ever absent from the capital city of China ; but there are some seasons, of which the 
above was a remarkable one, when it rages more virulently than in others. — 
(IV. 41.) In 1871, fever was the most fatal of all the ailments to which foreigners * '°^' 

in Peking were subject ; it was also, after small-pox, the most prevalent affection among the 
Chinese. It was called by the latter ' the hot disease.' Numerous cases of low continued fever 
are seen yearly in the summer. In that of the year under notice, a British subject is recorded as 
having died of typhus fever. He had shortly before his illness been engaged in superintending 
the cleaning out of a drain connected with the Legation, and his attack was assigned to that 
circumstance. — (III. 7.) 

In the Report to September, 1872, Dr. Dudgeon writes thus in regard to the death of three 
children which happened during the period then ended : ' Two of the children were carried off 
by diarrhoea. The third was removed by typhoid fever in the month of August, at the age of 
five years j the youngest foreigner that has died of this disease, and the oldest child among 



88 EPITOME or MEDICAL REPORTS. 

twenty-one that have died here during the last eight years.' In the case of typhoid fever, it is 
almost impossible to say how the disease was caught. One of the nurses, fifty-three years old, 
was discovered to be sick on the day of arrival at the hills. It was found that typhoid fever 
existed in her own family. She ultimately recovered. The little patient had no more intimate 
communication with this nurse than the other children and adults generally. The well-water was 
considered exceptionally good. The vegetables supplied were fresh^ and were not likely to have 
been washed in pools and city moats, whither all the refuse flows or is thrown. It is not yet 
proved that the exhalations of drains, privies, and stagnant surface-water do contain or dis- 
seminate this poison, or that through such exhalations it can be absorbed into the system. In the 
period to March, 1873, continued fever was pretty prevalent; this affection seems to be seldom 
completely absent from Peking. The wonder is that more persons are not attacked, when the 
filthy state of the streets and drains, and the careless and filthy habits of the people, are con- 
sidered. — (VI. 7-11.) In 1874 three foreign residents suffered from 'akind of low fever with much 
prostration but rapid convalescence,' and a number more were more or less out of sorts. Among 
the Chinese^ typhoid is one of the diseases to which much mortality is due. Typhoid is rising in 
importance. In the six months ending September of that year, four out of twenty-four deaths 
in hospital are recorded as from this cause. Pour were the entire number admitted for that form 
of fever. By a reference to the Medical Reports, No. IV., p. 33, it will be observed that from a 
table of mortality extending over twelve years, to typhus {typlioid) were due seventeen out of 
fifty-nine deaths. Twelve of these were Roman Catholic priests and sisters (seven and five respec- 
tively), who mix very freely with the people indeed — who seek out and visit the sick and dying. — • 
(VIII. 20-37.) Between October, 1874, and March, 1875, typhus fever prevailed, chiefly in the 
two last months of that period. It was entirely confined to the native Chinese ; and although 
several foreigners went in and out from the hospital containing such patients, none of them were 
attacked.— (IX. 40.) 

At Tientsin, during the spring and early part of the summer of 1877^ typhus^ typhoid, and 
relapsing fever raged among the native population. Later on, cholera prevailed. — (XIV. 66.) 
From October, 1878, to March, 1879, four cases of typhoid fever occurred. Of 
these, two were contracted in the settlement. In one case^ vf hich terminated fatally , 
the patient had been treating himself with large doses of sulphate of magnesia at one of the 
outposts: in three days he took 5J- oz. When first seen, his pulse was 140; temperature 103"2°Pahr.; 
breath very offensive ; tongue red and glazed ; four rose-coloured ' typhoid ' spots on the 
abdomen ; general tympanitis, abdominal tenderness, and gurgling in the right iliac fossa ; 
evacuations very frequent, horribly offensive, ochre-coloured, mixed with blood and shreds. The 
patient was very prostrate, slightly delirious ; he had voided a quantity of blood during the night. 
The intestinal haemorrhage continued at intervals in spite of treatment; on the sixth day after ad- 
mission there occurred symptoms of perforation ; general peritonitis set in, and death speedily 
followed. In January to March, 1879, both natives and foreigners suffered severely from an out- 
break of typhus. Small-pox was at the same time prevalent. The greater number of the typhus 
fever cases occurred among refugees from famine-stricken districts^ of whom a large number died. 
Children as well as adults suffered from the disease ; in them the characteristic rash was faint, 
' an irregular, mottling, dusky red fire, as if below the surface of the skin, and seen through a 
semi-opaque medium,' most marked on the inside of the thighs, on the axillary margins and on 
the buttocks. It is particularly remarked, with reference to the cases of typhus, that the 
distinctive odour was present in all. In their treatment early stimulation was required. — 
(XVII. 35.) 



CONTINUED EEVJLKS, ETC. 89 

At Newchwang, during the half-year to September, 1871, the circumstance is noticed that 
foreigners and natives equally enjoyed immunity from contagious fevers except small-pox, — 
(III. 12.) In the two years ending September, 1876, typhus fever occurred in the „ , 
persons ot two priests occupying a building m the same position as that in which a 
Sister died of cholera. Of the two priests, the attack proved fatal to one. The Mission 
compound had earned an unenviable reputation as being the one place in the neighbourhood of 
the foreign settlement where malignant fevers have prevailed among foreigners and Cliinese. — 
(XII. 29.) In the year ending March, 1878, there was throughout the period a good deal of low 
fever among the natives, its type not very distinct ; diarrhoea also prevailed, together with many 
ailments due to the absence of proper food among the population. Among persons who came to 
that place from Shantung, where famine was very severe, ' a kind of typhus fever prevailed.' 
Among the Roman Catholic Sisters, several cases of fever occurred during winter. In twD 
instances many of the symptoms of typhus were present, but there was no rash for a considerable 
time after being first attacked. Rheumatic pains and inflammation of both lungs were present, 
and subsequently the rash of typhus did make its appearance. Very great debility followed the 
attacks, but in both instances recovery took place. It was considered that the typhus fever was 
derived, from the poor who arrived from Shantung, of whom many were cared for by the Roman 
Catholic Mission. In a former Report (XII. 28), Dr. Watson remarked on the unhealthy 
house and compound in which the Sisters lived. Now they occupy the best built house in New- 
chwang, and a great deal has been done by drainage to improve the sanitary condition of their 
compound. What then — he writes — is the cause of the great sickness and mortality that distin- 
guish this Mission ? Among the causes he enumerates the ascetic life led by the Sisters, whose 
physique is never equal to. that of the lay members of the community. He describes the 
routine of their daily life, and adds : '' It is natural that under such circumstances vitality should 
be impaired, and that if fever is present, people so circumstanced should fall victims to it. If 
the prudence of those who are responsible for the working of the Mission was equal to the 
devotion of its agents, there would be less sickness and fewer deaths than unfortunately has been 
the case in past years.' — (XV. 28, 30, 31.) In the six months to March, 1879, one death is 
recorded under the head of puerperal fever, or, as stated within parentheses, from gastro-enteric 
fever; the age of the patient, thirty-four years. — (XVII. 11.) During the year ending March, 
1881, Dr. Watson observes that while there was the ordinary amount of sickness among the 
Chinese, almost every foreign resident suffered, and in some cases severely. The Chinese 
are crowded together, while the European community live in large compounds and in comfort- 
able houses far part from each other, have no drains, and have all noxious matters removed from 
their vicinity at short intervals. Fevers have in the past been common among the Chinese and 
unknown among the European community. This winter the tables are turned, and from some 
causes which we cannot discover, among other diseases enumerated, individual cases of typhus 
fever' occurred. A case of typhus fever occurred in the person of the Lady Superior of the Roman 
Catholic Mission. She recovered ; but in reference to it Dr. Watson again adverts to the 
monotony of life of priests and Sisters as constituting ' serious depressing factors.' — (XXI. 37-38.) 
In the Report on Chefoo— October, 1874', September, 1875 — Dr. Carmichael mentions 
Japan fever as observed at that settlement. All nationalities appear to be equally subject to that 
fever. The prominent symptoms resemble those of typhus, but there is less regu- cheloo. 
larity in its course than is observed in that disease. It is very contagious. The Japan Ferer. 
rash, mulberry in hue, appears early. There is often diarrhoea. Defervescence does not take 
place at regular periods. Hiccough sets in early, and is often severe. Certain nervous symptoms 

12 



90 EPITOME OF MEDICAL REPORTS. 

persist, ifc may be for weeks, a£fcei- convalescence. Facial or lingual paralysis may supervene 
after even slight attacks. Out of fifty cases, two deaths occurred. Post-mortem examination 
showed intense congestion of the cerebral membranes^ the spleen soft, extensive peritonitis, and 
perforation of the intestine.— (XI. 3.) During the year to September, 1876, Dr. Carmichael did 
not see a single case of typhoid or enteric fever either among natives or foreigners. — (XII. 44.) 
Early in the winter of 1877-78, a case of typhoid was imported. The subject of the disease was a 
seaman ; his first symptoms were diarrhoea ; he was treated with milk diet, and recovered. 
(XV. 18.) According to the Eeporfc to September, 1878, during the prevalence of typhus fever 
in the north, two cases of the disease occurred at this place. One of these, very severe in 
character, appeared to owe recovery to the free administration of alcohol. — (XVI. 15.) In the 
six months ending September, 1877, a case of typhoid occurred in a visitor. It proved fatal in 
seven days after his arrival, from perforation of the bowel. — (XVIII. 73.) 

At Chinkiang, during the half-year to September, 1876, the occurrence of a case of typhoid 
fever in a Chinese is mentioned. In it the axillary temperature rose to 104" Fahr. The patient 
recovered. — (XII. 27.) In the summer of 1877, a startling list of 'typhoid affec- 
lang. ^jQjjg > occurred among the native staff connected with the Customs establishment. 
The insanitary conditions of the locality, and contamination of the water-supply, are mentioned 
as causes of those affections. — (XIV. (Jo.) In the six-monthly period ending in March, 1880, it 
is recorded that a ' typical case of typhoid fever occurred in the person of a resident from 
Wuhu. It was described as typical; head symptoms marked; successive crops of rash; 
evacuations from the bowels, and thermometer indications all typical. A second similar case 
occurred in a Chinese, also typical. In the first-named case, when on the twenty-fifth day 
some wine was administered, an immediate rise of temperature to 10:2' Fahr. was the result; 
and a similar rise occuri-ed when the stimulant was resorted to three days afterwards. The 
patient recovered completely.' — (XIX. 7.) In the year ending March, 1881, some cases of typhus 
fever occurred. There was also a fatal case of that disease on board H.M.S. Pajasus; subse- 
quently other cases developed after the ship returned to Shanghai. Dr. White was of opinion, 
from inquiries made by him, that the disease arose on the north of the Yangtze, where great 
poverty prevailed among the people, and drought had affected their crops. The Fegasus had 
anchored near a small town in which several deaths had occurred from fevei'. Since January, 
1881, several cases of typhus have been recorded, and they have invariably come from the north, 
or contracted the disease from some one who had been in that direction. — (XXI. 98.) 

At Kiukiang, during the half-year ending oUth June, 187:3, a case of continued fever, or 
tijj^ihus mitlor, was recorded. It occurred in the person of a marine on board H.M.'s gunboat 
Dove. The patient was seen for the first time on February 10 th ; crisis took place 
on the fourteenth day; convalescence was interrupted by 'latent or masked 
pneumonia,'' and resolution of the same took place in seven or eight days. — (III. 58.) A flood 
having occurred and lasted from 21st July to 17th September, 1879, the low-lying country for 
many miles around was submerged and many of the people reduced to a state of destitution. 
Typhus, and other diseases affecting the destitute, broke out among them. The general sickness 
and want were speedily mitigated by the distribution of relief. A case of typhoid fever was also 
recorded — the first during five years. The sanitary condition of the settlement was fairly satis- 
factory. The assigned cause of the disease was milk diluted with stagnant water ; yet a second 
person who partook of the same milk vomited, and had no fever. In the treatment good results 
followed the administration of stimulants and good food. — (XA^II. 2,3.) During the year endino- 
March, 1880, a case of typhoid of great severity was recorded as having occurred in the foreign 



CONTINUED FEVERS, ETC. 91 

community. — (XIX. 9.) In the year ending March^ 188], a larger number of missionaries than 
usual arrived from the districts, suffering from dysentery and fever.— (XXI. 48.) 

At Hankow, in 1871, the usual absence of enteric affections was remarked upon in connection 
with the system practised by the Chinese of extensively irrigating their fields with decomposing 
night-soil; also that the form of fever which usually prevailed was not of the 
continued, but rather of the remittent type.— (II. 44) According to the Eeport 
for the half-year to March, 1872, ''the failure to discover any type of exanthematous fever is 
scarcely what might have been anticipated, considering the filthy condition of the houses and 
streets, the density of the population, and the poverty in many parts of the native city. It might 
have been presumed that the haunts of enteric fever at all events would have come to light, 
seeing that the products whence its organisms are supposed to be derived and nourished 
abound in all directions. The latrines are numerous. Their contents are allowed to accumulate 
for three or four weeks ; they are then disposed of to the farmer or gardener, and carried to the 
jetties in uncovered buckets. While the process of emptying the troughs is going on, the neigh- 
bourhood is saturated with odours of the most intense description, and which defy the tolerance 
of even well-blunted olfactories. Dr. Held refers to the theory of M. Boudin and some American 
physicians, that where malaria exists, or in a body of men who have suffered from aguish fevers, 
there is a neutralization or tolerance of the enteric poison. At Hanlww, however, there was 
certainly no evidence in the form of malarious fevers here to confirm the opinion expressed by 
Dr. Harley that these fevers and enteric fevers are developed amidst the same conditions.-' — 
(III. 43, 44.) In the period ending September, 1872, a considerable number of cases of fever, 
periodic and continued in type, occurred. The reporter writes that ' it has hitherto been found 
impossible to induce continued fever patients to reside in hospital, as neither they nor their 
friends comprehend the natural resolution of many fevers ; they expect and are clamorous for the 
promised remedies which will forthwith extinguish the disorder.' — (IV. 74.) During the summer 
of 1874, cases of fever, ague, and dysentery were met with among foreigners. Of fifteen cases of 
fever in Chinese treated at the dispensary, four were distinguished by the temperature 
reaching 104° to 105° Fahr. Fever and dysentery combined were frequently seen in dispensary 
patients.— (VIII. 43.) In the half-year ending September, 1875, fever, more particularly of the 
continued type, prevailed. It rarely set in with marked rigors; it was accompanied with nei'vous 
prostration j it lasted two or three weeks, during the last of which profuse perspiration took 
place. Full doses of quinine, i.e. 20 to 30 grains night and morning, exercised no specific effect 
on the disease while the patient remained in a malarious neighbourhood. — (X. 46.) 

In the Eeporfc for the year ending 30th September, 1876, Dr. Eeid considers the question as 
to whether an ' antagonism ' exists or not between typhoid and endemic malarial fevers. His 
own experience at that place tends to confirm an opinion expressed by several Typto-malavial 
writers, that typhoid fever is rarely found under such conditions. He writes : Fever. 
' The difficulty of defining some of the fevers encountered in malarial and stercoraceous 
atmospheres has of late given rise to the term " typho-malarial ;" and if this term be applied to 
malarial fevers which exhibit many of the symptoms of typhoid, but without the characteristic 
roseola, it would include one type of fever prevalent; here.' Then follows a note from the British 
Medical Journal for September, 1876, according to which 'there is a report of an epidemic of 
typhoid fever in Paris, where rose-coloured papules were absent in the majority of cases.' — 
(XII. 14.) In the half-year ending March, 1881, besides a prevalence of periodic fevers, a con- 
siderable number of those of the continued fever occurred. Of the latter, fifteen in the native 

12—2 



92 EPITOME OF MEDICAL REPCRTS. 

Chinese presented all the symptoms of typhoid, except those of rash and of the alvine motions ; 
two of these cases proved fatal. — (XXL 45.) 

At Shanghai^ according to the Report for the half-year ending Septomberj 1871, no authentic 
case of disease had been observed from the adoption of sewage irrigation in the neighbourhood of 
the farms so treated. Among the diseases 'which may, with more or less pro- 
™^ ""■ bability, be ascribed to climatic causes, Dr. Jamieson enumerated hepatitis and 
dysentery; to local causes, typhoid and small-pox ; to the action of the sun, and no doubt aided 
by personal habits, typhus, sunstroke, delirium tremens, meningitis.' He observes that ' the 
differences between these classes it is difficult, and often impossible, to draw accurately.' In each 
month, from April to July, one case of typhoid was recorded. The various forms noted as occur- 
ring among foreigners include febrioula, typhus, typhoid, periodic, and 'bilious.' — (II. 33, 37.) In 
that to Marcb, 1872, Dr. Eeid wrote: 'It might have been presumed that the baunts of enteric 
fever would have come to light, seeing that the products whence its organisms are supposed to be 
derived and nourished abound in many directions.' (The conditions are then described, as already 
given under the head Topogeapht, of this settlement, p. 30.) He then continues : ' These various 
prolific sources for the development of organic germs have been specially referred to in connection 
with the absence of enteric fever, because it may happen that in time evidence maybe collected to 
prove or contradict an important theory in relation to this fever,' namely, whether where malaria 
exists there is neutralization or tolerance of ' enteric poison.' — (III. 43, 44.) 

Prom April to September, 1872, according to the Report by Dr. Jamieson, 'typhoid' fever 
presented no special features. Two severe cases occurred; both ended in recovery; 'in neither of 
these was any treatment worth mentioning adopted, except the liberal use of wine and milk, and 
due attention given to hygienic conditions.' Typhus fever is luckily rare, as when it occurs it is 
almost uniformly fatal. — (IV. 96.) 

In the Report for September, 1873, Dr. Jamieson writes: ' Dysentery and typhoid fever are 
bere constantly lying in wait for the unwary. Whether the form.er disease is always specific is 
fairly open to doubt, and the specificity of the latter is denied by one of the greatest livino- 
authorities on the subject.' — (VI. 50.) 

In the Report to September, 1874, the medical officer discusses the subject of ' enteric ' fever. 
He observes that in India that disease occurs spontaneously in young soldiers. He writes : ' An 

In Indi'i inspection of Dr. Bryden's reported cases stows how closely malarial fevers occa- 
sionally run with typhoid. Thus the diagnosis in oases noted as ague or remittent 
is frequently amended on the appearance of a typhoid rash, or other characteristic symptom. 
Instances reported will prove that cases set down as " remittent" would, had there been an erup- 
tion, or iliac pain or gurgling, have been entered as "typhoid." The entire subject of the 
dependence of disease upon organic efHuvia is enshrouded in mystery. Ou the one hand there 
is evidence which cannot be gainsaid that sewer gases when admitted into a house are a fertile 
source of typhoid fever : these gases are products of organic substances. On the other we have 
equally distinct evidence that workers in drains are not specially subject to typhoid, althouo-h 
Murchison explains this by the protection aJSorded by age, by previous attacks and by leno-fchened 
exposure.' The effiuvia given ofi: in the process of tanning, soap-boiling and gelatin-makino- 
although insupportable to those unaccustomed to them, are in no way injurious. He sums up 
tbua : ' Our knowledge of the etiology of the great majority of diseases is purely empirical, but it 
is our duty to eliminate, as far as may be, all apparent sources of danger.'- -(VIII. 17^ 18.) 

Malarial and typhoid fevers were common and severe during the last quarter of 1874 and first 
quarter of 1875. In tbe earlier months of the half-year, remittent fever at Shanghai was found 



CONTINUED rEVEES, ETC. 93 

associated with intractable dysentery, or followed by obstinate diarrhoea. Dr. Jamieson observes 
that in his previous Eeport he drew attention to the fact that, of late, the severer type of remit- 
tent fever is approaching closer and closer to that of typhoid, and that cases of true typhoid are 
rapidly increasing in number.— (IX. 7.) 

During the six months, from April to September, 1875, sun malaise was common in July ; 
throughout the whole period intermittent and remittent fever occurred, ' and a few doubtful typhoid 
cases.' Dr. Jamieson says : ' Of late years, and especially in Germany, the subject of ground 
emanation— in relation to cholera and typhoid fever— has been carefully investigated by Petten- 
koffer, of Munich, and others. The simple fact is that during sixteen years in lyr ■ i, 
Munich^ he found that the mortality from typhoid fever varied with pretty constant 
regularity inversely as the height of the ground-water. But the variations in the ground-water 
level are taken merely because they measure most accurately the dampness of the soil' Advert- 
ing to the occuri'ence of a fatal case, returned as of enteric fever, he observes that it may have 
been one of abscess of the liver. The patient died at sea, and the symptoms during life were very 
doubtful.— (X. 55-59.) 

In the half-year to March, 1876, an apparent increase in the cases of ' typhoid ' fever took 
place; some cases of the type so named were accompanied by pueumonia. Dr. Jamieson wrote : 
' It is probable that to a notable extent the late apparent increase in the number of such cases 
is due to the fact that cases which a few years ago would have been classed as " Shanghai remit- 
tent " are now more correctly referred to typhoid.'' — (IX. 50.) In the succeeding six months, 
namely to 30th September, 1876, a case of 'enteric' fever, with violent delirium, is recorded as 
having taken place in a child of eight years old. — (XII. 3.) In the half-year to March, 1877, 
malarial fevers were among the prevailing diseases. No death by enteric fever occurred in 
hospital, and only one in private practice.— (XIII. 44.) 

In the returns for the half-year, April to September, 1877, the reporter bracketed together 
the deaths from enteric, gastric and remittent fevers, enteritis, and chronic enteritis, on the 
ground that ' it is probable that all might fairly come under enteric fever.' Of the latter disease 
he states that there were several cases of more or less severity, especially in July and August ; 
but only three deaths among adult residents could be ascribed to this group. — (XIV. 44.) 
According to the Report for the period ending March, 1878, no death by enteric fever occurred 
among the residents. Tliis disease, however, has been constantly present, and appears to have 
completely replaced the old Shanghai, that is remittent fever. — (XV. 6.) In the Report for the 
half-year to September, 1880, allusion occurs to typhoid conditions occurring from different 
causes. Two cases are recorded in which the symptoms were those of profound ' blood-poisoning,' 
depression, rapid exhaustion, variable but never high temperature, profuse perspiration, yellow 
staining of the skin, night delirium, transudation of altered blood through the mucous membranes 
except that of the mouth, profuse emanations of broken-down blood, epistaxis, expectoration of 
blood-stained mucus, no tympanitis, no exanthem till two days before death, when a mottling of 
petechise, resembling typhus rather than typhoid, occurred in the abdomen. There were no sores 
on the mouth nor swelling of the gums. These cases were treated with hot cataplasms to the 
abdomen, quinine, ergot, wine, lemon-juice, salines, conCenti'ated nourishment, but without benefit 
--(XX. 34.) 

In the Report to March, 1881, Dr. Jamieson wrote: 'Fifteen years ago some of the older 
practitioners denied positively that typhoid fever was ever seen among foreigners in China.' He 
expressed an opinion that more accurate diagnosis now refers a large number of cases to typhoid 
which, at an earlier date, would have been classed somewhere under the heading of malarious 



94 EPITOME OF I\[EDIl'AL REPORTS. 

aSections. He has cause to believe firmly that the remittiDg fever, which lasts more than a week 
and does not yield to anti-periodics, is typhoid. Some cases of remitting fever which, before being 
seen by him, have been treated fruitlessly with quinine, yield when the drag in interrupted, and its 
administration resumed after the action of an emetic, or of a purge, or when it is combined with 
salines or with arsenic. But when it is clear that anti-periodics are o£ no use, that they are 
hurtful, the sooner they are abandoned the better. In these cases, he has no doubt, we have to 
deal with typhoid, although there may be neither delirium, diarrhoea, eruption, nor tenderness in the 
ileo-ctecal region. Dr. Jamieson then gives a clinical history of a case of typhoid fever, treated 
by him in the month of May, and in which recovery took place. Continuing his Eeport for the same 
period he observes that typhus fever appeared as a cause of death for the first time since 1878. One 
of the cases occurred on board H.M.S. Pegasus, hut yvhether the other two originated by contagion 
from it, he is unable to say. The disease is rare in Shanghai. During the half-year from April 
to September, 1871, four fatal cases by this form of fever occurred; in the corresponding six 
months of 1872 five deaths were attributed to it. From that date till February, 1878, no recur- 
rence of the disease occurred, but in each of these months a death from this cause was recorded. 
Dr. Jamieson writes : ' The immunity from typhus enjoyed by foreigners in Shanghai is surpris- 
ing, and is not likely to be permanent, considering the overcrowded state of the most central 
portions of the settlement, the want of ventilation, and the incredible filth of the Chinese popula- 
tion living in their midst.'' He accordingly urges the necessity for improvement in those 
conditions. In the above case the disease was suggested to have been contracted at Chinkiang-, 
and inquiries among the mandarins confirmed the impression of Dr. White that the disease arose 
on the north of the Yang-tze, where great poverty existed, and which was enhanced by a continu- 
ance, during several months, of dry weather. The Pegasus anchored near, and to leeward of a 
village where several deaths by fever occurred. — (XXL 81, 82, 9'.J.) 

In the half-year ending September, 1881, two deaths by enteric fever are reported, and later 
in that year four more fatal cases of that disease. — (XXII. 51.) 

At Ningpo, during the half-year ending March, 187l!, a death by enteric fever in a foreigner 
was recorded. The temperature rose to a maximum of 105 Falir. on the twelfth day. The 
patient died on the twenty-sixth day, being conscious up to within a few hours of 
his death. — (V. 25.) According to the Eeport for the half-year ending September, 
1880, few persons escape having fever. That which most prevailed among the foreigners was 
remittent in type. In some cases its early stage was characterized by a temjierature of 'J'X to 
100° Fahr., in others ](J2' Fahr., and in a third class lOo' to 105° Fahr. The disease lasted nine 
days to six weeks, but seldom proved fatal. The lowest form of fever cannot well be detected 
without the thermometer ; and when this instrument is not used. Dr. Henderson is of opinion 
that it may run on for months without being diagnosed. — (XX. :jO.) 

At Foochow, in the six months from April to September, 1871, Dr. Somervilie saw several 

cases of true typhoid in seamen, but observed that they were comparatively rare. In his practice, 

extending over nine years at that anchorage, he had never seen a case of tvphus 

Foocliow. • 

iraui-itiua FcTer ^^^^^^ on shore or afloat. Fever of the remittent type is not uncommon, so also with 
intermittent. He has seen one instance of what is called ' Mauritius fever,' namely, a 
kind of remittent characterized by extreme debility, with tendency to complication in the digestive 
organs, particularly the spleen, with frequent relapses. The case recovered, but convalescence 
was very slow.— (11. 30.) From April to September, 1872, fevers, both continued and periodic, 
were numerous.— (IV. 58.) During the six months from October, 1872, to March, 1873, four 
cases of typhoid fever were observed. There had been no case of the disease for over three 



CONTINUED FEVERSj ETC. 95 

years; and in eleven years before the present date, the reporter had only seen seven or eight 
cases of the disease altogether. Eecords do not appear regarding the etiology of the disease ; 
but ' all cases were treated on the principles laid down by Sir William Gull, namely, few or no 
drugs, careful nursing, milk, soups, and stimulants.^ There was no evidence of the disease being 
infectious, and the few cases which occurred must be put down as spoi-adic. — (V. 39, 41.) In 
the Report to March, 1874, the forms of fever which occurred, differed in many respects from 
the recognised type ; they were considered as in character ' mixed.' — (VII. 9.) In the period to 
March, 1876, zymotic diseases, so fatal at home, had hardly an existence here, with the exception 
of typhoid fever, which appeared in sporadic cases now and then. — (XI. 39.) In the period from 
April to September, 1877, one case of typhoid occurred. It was considered to be one of ' genuine 
typhoid, but without much diarrhoea ;' and two others, ' that formerly would have been re- 
turned under the vague designation of continued fever,' but which the reporter considers 
to have been cases of ' abortive typhoid.' He quotes from Dr. Aitkin that many of the cases 
which former writers call ' gastric fever ' or ' nervous fever,^ are to be regarded as abortive 
typhus. — (XIV. 86.) In the Report for 1879, the statement occurs that formerly typhus fever 
used to be rather frequent, especially in one Missionary compound, where the wells were sunk 
below the level of some adjoining filthy buildings. Latterly these conditions have been rectified, 
and typhus has given way to remittent. It appears that typhus when it did exist was mild ia 
type, the only fatal case of this affection having occurred in a person who arrived from Hong Kong, 
suffering from the disease in an advanced condition. — (XVIII. 66.) According to the Report 
for the year ending March, 1881, typhus and typhoid fevers are endemic. Of fevers which 
occurred there were three cases of typhoid or enteric and four cases of ' a continued fever of the 
remittent type, over which quinine had no influence whatever ;' these cases occurred during the 
winter months. The same Report states that three cases of typhoid fever were recorded, namely, 
one in October and two in February. In one of these ' the physiological effects of quinine were 
produced, but having failed to influence the course of the fever the drug was abandoned.' After 
the suspicion of enteric fever as the cause of illness, ' beyond small doses of Dover's powder to 
control the diarrhoea, no medicines were given.' A case of typhoid in a native has not come 
under the notice of Dr. Rennie; but fever cases of any kind seldom come to hospital for treat- 
ment. Frequently patients suffering from debility, and with the listless exhausted appearance of 
those convalescing from enteric fever, and having a previous history of two months' fever with 
diarrhoea, visit the hospital. — (XXI. 52, 54, 55.) 

As recorded in the Report on Amoy for the six mouths ended September, 1871, 'there is no 
typhus, no typhoid or other disease considered the inevitable consequence of defective sanitation, 
although Amoy is full of typical typhus-dens. Luckily, filth, overcrowding, and 
bad food are not the only factors necessary for the manufacture of a typhus 
epidemic J were they so, we should live here in perpetual dread.' — (II. 11.) In the period to 
March, 1872, a case of typhoid fever occurred in the person of a mate on board a French brig 
arrived via Chefoo from Japan. In the previous four years, eight cases of that disease had been 
treated, the patients in all instances having arrived from Japan. — (III. 23.) In that from April 
to September, 1872, a case of typhoid fever was imported from Chefoo, in the person of a sailor 
who had recently arrived at the latter place in his ship from Hong Kong. For a time diagnosis 
was obscure — cough suggesting- tuberculosis, and there being an absence of iliac tenderness and 
diarrhoea ; the surface was covered with prickly heat, and no distinctive typhoid eruption was 
apparent. After a tedious illness, the patient recovered. The reporter observes with regard to it 
that its characters prove unmistakably the existence of typhoid fever in China. — (IV. 0.) In thg 



96 EI'lTO.nE OF MliDICAL llEPOKTH. 

half-year to March, 1873, one case of typhus fever was recorded. The patient had come from Woosung; 
the symptoms well-markedj rose-coloured spots and temperature more characteristic. 'Although 
his ship had been anchored in the river at Woosung, he did not go on shore, nor did the ship take 
in water there ; so it was difficult to say how he became infected.' — (V. 9.) In the period from April 
to September, 1875, four cases of typhoid fever occurred among the foreign population, namely, 
one on shore and three afloat; of the latter, one imported from Shanghai, two on board H.M.S. 
Eari. — (X. 26.) In the period to September, 1870, typhoid fever of local origin occurred, as this 
disease had done during the preceding winter. The first of these cases occurred in the person 
of a Portuguese; the second in a Chinaman, the disease in both attacking them at Kulangsu. 
During the months of March and April, 1870, several children were attacked by a febrile disease 
characterized by high temperature and bronchial catarrh, but without eruption. Several of the 
cases were severe, but recovered after illnesses of from seven to ten days' duration. The Chinese 
suffered to a less extent than usual from fever during this time. — (XA'III. 58, 50.) In 1881 an 
epidemic of fever prevailed. The type was continued, of a somewhat anomalous character. It 
was circumscribed as to locality; prevailed chiefly among the Chinese, but attacked also a few of 
the foreign residents. The group of houses from which all the Chinese cases came was situated at 
the foot of a hill near some rice-fields ; there are many low-placed wells exposed during showers 
of rain to receive garbage from the neighbouring surface. Prom these wells water is used by 
washermen, and probably to mix with 'ouffalo-milk sold to foreigners. But the Chinese do not 
themselves make use of milk, which they look upon as an excretion. Preceding the outbreak 
there had been some rainy weather. All the foreigners affected obtained their milk-supply from 
this dairy ; others not affected, from another dairy — a circumstance significant, bat not neces- 
sarily associating the milk-supply and sickness among foreigners as cause and effect. As 
examples of the fever among Chinese the following cases are given, viz. : 1. A lad about 
18 years of age; symptoms resembling typhoid fever — high fever, furred tongue, low delirium, 
stupid countenance, diarrhoea, abdominal tenderness. Quinine administered without benefit ; all 
drugs then put aside ; careful feeding observed. Had been ill about 26 days when first seen ; 
about 40 days afterwards left hospital, very weak, emaciated, with loss of vision of one eye from 
sloughing of the cornea. 2. This lad's father had a milder attack of the same disease. 3. His 
mother ill 31 days with what was described as quotidian ague. 4. A girl of about 17 years old. 
On 15th August felt giddy in the morning ; had a rigor rapidly followed by high fever and 
delirium; when seen three days afterwards was moribund, and quickly died. 5. A young brother 
of the last who slept in the same bed as her; attacked on IGth with smart fever; quinine sub- 
cutaneously injected, and on 22ud was well and left for home. 6. A lad, ill in May; fever, 
frequent epistaxis ; no diari-hoea. Quinine ordered. Towards the end of June his permanent 
temperature was 10.5° and lUG' Fahr. ; emaciated, skin harsh, dry; slightly furred tongue ; no 
delirium, diarrhcea, abdominal tenderness, petechias, nor apparent visceral disease. Quinine 
given in large and oft-repeated doses, and under it recovery slowly took place. 
! With reference to these cases the remark occurs that the usual autumnal cfudcm ic of malarial fevers 
did not begin till the middle or end of September. Among foreigners the cases were : 7. Mi*. A., 
Autumnal Mala- the employer of the patient last indicated. Taken ill about 10th June ; slight chilli- 
naiFcTers. ness, then feverishness every afternoon, succeeded during the evening and night by 
perspiration, then an intermission from morning till 2 p.m. ; no diarrhoea. Quinine did not check 
the attacks till he took a sea-voyage to Tamsin ; on his return to Amoy, he had slight relapse. 
8. The wife of above. On night of 26-27 June had shivering, then violent fever followed by 
perspiration; on 28th similar attacks; on 20th four distinct paroxysms of rigor, fever, 



CONTINUED PEVERS, ETC. 97 

diaphoresis; temperature of skin, 105° Falir. Quinine in small doses, then in large. The fever 
became continued, diarrhoea set in ; on 1st July miscarried, and collapse threatened. Under lead 
and opium began to recover, but a bed-sore formed on one gluteal region. She gradually 
recovered, but her hair fell off. While she was ill three other grave continued-fever cases 
occurred in foreigners, 9. Mr. B., at beginning of June, had an attack of ordinary summer 
diarrhoea ; this began to abate, but on the 1 0th of that month he felt feverish. Feverishness and 
diarrhoea set in together, and persisted till 27th or 28th day of illness; skin temperature, 
103° Fahr. or 104'5° Fahr. ; no marked iliac tenderness, nor enlargement of spleen; delirium of 
typhoid character, subsultus, and a few rose-coloured spots. At first drugged with quinine 
without benefit ; during the latter period treatment entirely ' expectant.^ 10. Miss 0. had languor, 
headache, pain in limbs, and fever. Took quinine without benefit. On 7th day of illness, tem- 
perature 103° Fahr., diarrhoea present and, with the fever, continued for a week; no spots, 
splenic enlargement, nor iliac tenderness. On 21st or 22 nd day, convalescent. 11. Mrs. D., 
attacked on 4th June with fever, diarrhoea, and pericardiac oppression. Living in a malarious 
locality. On the 28th day temperature had fallen to normal ; a relapse then occurred, and not till 
the 7th week could she be pronounced convalescent. 12. Mr. D., her husband, about 26th July, 
suffered from headache, lassitude, anorexia, fever, but without diarrhoea. Was treated with 
apei-ients and quinine ; toward the end of the second week he slightly improved, but relapsed, and 
only began to recover early in the fifth week. 

Relative to the above cases it is stated that in every one occurring in foreigners the hair fell off. 
Of the six foreigners attacked, four were missionaries ; the cases occurred in three different houses, 
two close to each other, the third in a high and salubrious situation. The hypothesis of those 
attacked having been exposed to specific poison was opposed by the fact of the other two cases, 
husband and wife, living at a distance from and being unconnected with the missionaries. The 
only circumstance in common among them was their milk- supply already mentioned; the dairy, 
or dairies, being situated in the focus of the epidemic among the Chinese. In 1878 there had 
been a localized epidemic of fever in the same houses now attacked. That this disease was genuine 
typhoid is by no means certain. In some cases supposed ' characteristic ' symptoms were present ; 
in others, except that the fever was continued, and uncontrolled by quinine, there was no evidence 
of its typhoid nature. One instance was decidedly intermitting, yet quinine failed; in another, ifc 
seemed to cut the fever short at once. In place of candidly admitting that we really know little 
or nothing of the real nature of anomalous fevers, such as the above, it has been aflBrmed that 
they are a combination of ordinary typhoid and intermittent or remittent fever, and the name 
typho-malarial applied to them. The writer does not think there is sufficient evidence for the 
existence of hybrid fevers. If we believe in the germ theory of fevers, and that the germs are 
specifically distinct, it is diflicult to conceive of the marriage of the distinct species ; it is not 
likely that the specific typhoid germ and the specific malaria germ could combine to produce a 
hybrid germ. The truth is, we are nearly entirely ignorant of a number of specific fevers which 
from time to time affect the inhabitants of foreign countries. Cases of continued fever, both in 
foreigners and natives, are often met with which do not admit of diagnosis and classification. In 
illustration the case is given of a patient from Tamsui suffering from ' Tamsui ' fever. On 23rd 
November, felt pain in left side ; 24th, was feverish ; 25th, rigors and much prostrated — took some 
quinine,but the fever continued; on 29th, arrived at Amoy, had considerable fever, prostration, pain 
in limbs, epigastric tenderness, tongue furred, whole body covered with an exanthem — the spots small, 
red, not elevated, disappearing on pressure ; on 4th December, perspired freely, and the eruption en- 
tirely disappeared. From that date improved, and from 20th day of his illness was convalescent. 

13 



98 EPITOME OF MEDICAL REPORTS. 

This case liad some characters o£ mild typhus^ but others were absent. A lighthouse-keeper was 
brought this summer from Chapel Island, a bare rock miles from any land or opportunity of infection, 
ill with a continued fever. On 7th day of his illness he had much headache and was a good deal 
excited, but beyond those of simple continued fever had no particular symptom. His temperature did 
not reach the normal point till the end of the third week. He took abundance of quinine, but without 
curative effect. What were these cases ? the reporter asks. Certainly neither typhoid nor malarial. 
Besides the acknowledged exanthomatous fevers, whose characters are well-known, there occurs 
in China a miscellaneous collection of fevers, whose diagnosis and treatment the medical man has to 
make out for himself. A certain proportion of these may be relegated to ' malaria,^ but others can 
neither be classed as exanthems nor malarial. Yery soon after arriving in the country, the reporter 
learned to separate the non-exanthematous fevers into thosein which quinine acted speedily and those 
in which it had no specific action. Griven a fever which does not subside on administration of the 
proper specific for malaria, the conclusion is justifiable that such fever is non-malarial; if such 
fever subsides after a week or two spontaneously, and is not succeeded by the consequences of 
malarial poisoning, there is abundant reason to pronounce it non-malarial. He remarks that one 
gets little satisfaction on the subject from books. Certain classifications are proposed ; but when 
the attempt is made to attach a name to a given case, the attempt is seldom satisfactory. 

Alluding to existing discrepancies of opinion, he thinks that the clue to proper classification of 
tropical fevers will not be found until investigators disabuse their minds of the idea that these fevers 
must be modifications or combinations of two poisons only, the typhoid and malarial. We are 
too apt to assume that we can assign correctly the various causes of disease, and dislike to think 
that there are forces and poisons in nature of whose existence we are ignoi'ant. — (XX. 2-9.) 

At Tamsui and Kelung, in November, 1878, a fatal case occurred of fever complicated 
with diarrhoea. These affections had for a long period persisted in the patient^ a person 
advanced in life, and who had passed many years in the East ; finally, death 
occurred by exhaustion.— (XVIII. G4.) In the six months from April to September, 
1880, one or two instances of continued fever, lasting for two or three weeks, with a high tempera- 
ture, sometimes up to 103° Fahr. or 104° Pahr., with no skin eruption, and apparently unaffected 
by medication, certainly not improved by quinine, were under treatment. In these cases long 
exposure to the heat of the day seems to have been the exiting cause. Dr. Ringer having given 
details in regard also to the occurrence of malarious fevers at these places, thus continues his 
remarks : ' All such cases as the foregoing, namely, of continued and of periodic fevers, are 
generally put down to the influence of malaria, from which it seems to him that our knowledge 
of the pathology of malarious disorders is at present somewhat imperfect ; and much good work 
might, he thinks, bo done in this direction by careful records of all such cases in different localities, 
with notes of habits of life and age of patients, condition of dwellings, influence of treatment, etc' 
—(XX. 16.) 

At Swatow, during the period from April to September, 1876, a case of typhoid fever arrived 
from Newchwang. The subject was a child, who had been ill from the beginning of April, when 
Swatow ^^^^ ^^^^ ^y ^'^' ^'^^^^- T^^ early symptoms recorded were diarrhcxa and fever. 
Eecovery ultimately took place. Dr. Scott adds, that ' in many cases of enteric 
fever which camo under his notice, though not at this port, during the previous three jchk, he 
had obtained excellent results from the free exhibition of ijuinine.' — (XII. 20.) In that to 
September, 1877, several cases of continued fever occurred among the shipping, details of which 
are given. In reference to the cases described, the medical officer observes that one was more 
like typhus than typhoid, though the rose-coloured spots made their appearance during the course 



CONTINUED FEVERS, ETC. 99 

of the fever, ^^'ith regard to a second, lie declared it probable that the patient had gone through 
an attack of typhoid, but had lain down only at the last moment. — (XIV. 68.) 

During the half-year ending March, 1878, together with the prevalence of diarrhoea and 
cholera among the Chinese, much fever and constitutional disturbance generally attended attacks 
of the former disease. During the winter of 1878, a case of a peculiar form of fever ,. ^ 

Tmi 1-1 T'lTo n „ Peculiar Fever. 

occurred, ihe subject was a child, five years of age. The illness began with pam 
in the left ear. The day following several red patches, the size of a hand, appeared on different 
parts of the body, especially the chest and abdomen; towards evening, a severe but short con- 
vulsion, then several partial convulsions, followed by unconsciousness. On next day, temperature 
of skin 104° Fahr., with nervous twitchings ; then cough, with mucous r^les in right lung. For 
several days these symptoms continued very severe; diarrhoea succeeded, then slow convales- 
cence j but from the ear profuse and offensive discharge set in and persisted long. — {XV. 23.) 

In the period to September, 1878, together with the usual amount of diarrhoea and intermittent 
fever, two cases of typhoid fever occurred in the early part of summer. In the Eeport under notice^ 
one of these is thus reported: A case of typhoid fever occurred in the beginning of April, 1878. The 
subject of attack was a sailor arrived from Bangkok. During the passage from that place, extending 
over five weeks, he had suffered from fever, profuse perspirations, sudaminee, diarrhoea, and great 
debility. On reaching Swatow, he was treated with quinine. He continued, however, to get worse; 
diai'rhoea peristed, with tenderness in the iliac fossae — no spots are mentioned. The subsequent treat- 
ment consisted of brandy and opium ; linseed poultices ; milk diet. Bed-sores occurred ; but on the 
GSrdday convalescence had sufficiently advanced to admit of the patient rejoining his ship. A se- 
cond case of fever with diarrhoea was designated ' enteric fever.' It also occurred on board ship; but 
on the 15th day diarrhoea ceased; a few 'spots ^ appeared on the abdomen; subsequently there was 
constipation, and on the 3 1st day of illness the patient was discharged. The treatment is un- 
recorded. — (XVI. 26.) In the sis months ending 30th September, 1879, some severe cases of 
fever and dysentery occurred. Two fatal cases of typhoid were recorded — one in a sailor, the 
second in a resident. In the same Eeport, the recurrence of a peculiar kind of fever was men- 
tioned. Its type was more continued than remittent; children its only subjects. It began with 
a rigor or pain in a limb or ear ; great irritability of temper, loss of appetite, disinclination to 
move, and vomiting. About the third day headache comes on, with congestion of the eyes and 
flushing of face ; then large red blotches on some part of the person, the blotches either in raised 
patches, or like urticaria, and these, after existing a few hours, disappear. The next symptom 
may be convulsions or delirium, or these alternating, with high temperature, 104° Pahr. or 105° 
Fahr., pulse 120 to 140. For a time the fever usually intermits for a couple of hours during the 
twenty-four hours. This continues during a few days, attended by chest complication in the first 
instance, subsequently by the abatement of these and of the fever, to be followed by recurrence of 
the latter, and now diarrhoea, the evacuations unhealthy-looking, for a few days. The attack 
usually runs its course in twelve to twenty days. In the treatment of such cases, grey powder 
and quinine were the remedies trusted to. Complications were treated as they occurred. — 
(XVIII. 75, 76, 79.) In the period from April to September, 1881, there occurred one case of 
typhoid fever, namely, in a child seven years old, also a case of continued fever in a child of two; 
recovery took place in both. — (XXII. 4.) 

At Canton, in the half-year ending September, 1871, intermittent and remittent types pre- 
vailed among the native Chinese, and ' fevers ' among foreigners. Fever in its canton 
various forms constitutes the bulk of the practice of Chinese physicians. With 
the advent of cool weather in September, the severer forms of fever disappeared, to be succeeded 

13—2 



100 EPITOI^IE OF MEDICAL REPORTS. 

by catarrhal affections and mild intermittents. Foreigners chiefly suffered from intermittents, 
the Chinese from remittents. In fact, the diseases that prove most fatal to the Chinese popula- 
tion of the city every summer ai-e remittent and continued fevers, including under these some 
fevers that are more or less amenable to treatment, and others of the most intractable character. 
For the treatment of fevers, especially those of the continued form, the Chinese rarely send for 
European physicians ; and it must be allowed that in these the native faculty manage to make 
many cures. — (II. 70.) According to the Report for the year ended March, 1872, the medical 
officer had only seen two cases of enteric fever among foreigners at that settlement during the 
preceding ten years. If foreigners are sometimes attacked by it, Chinese may be considered not 
to be altogether exempt ; but foreign physicians have not hitherto been afforded sufficient 
opportunities of seeing the fevers of the Chinese to enable them to distinguish by personal obser- 
vation the varieties that exist among them. The natives have no faith in the skill of foreign 
physicians in the treatment of fever, and when taken with it do not send for them, nor do 
they come to hospital to be treated as indoor patients. Among the outdoor patients, the 
fevers treated are usually intermittents. From native books and physicians no distinct idea can 
be gathered of such a disease as typhoid fever. In reference to the question of sewage, in 
relation to enteric fever, the medical officer says that in Canton large numbers of the native 
population are daily using water and inhaling air charged with the impurities of human excreta, 
apparently with utter impunity. Then follows a description of the water of the San-t'-sung 
creek, as already given (p. 63) under that heading in the topographical notice of Canton, to which 
the reader is referred. — (III. 20.) 

Throughout the year ending September, 187'.J, but more particularly in summer, the native 
population of Canton suffered from virulent fevers, to which they give the name of Gluit-pan — 
meaning ' spotted fever,' though in very few cases are spots visible. The fevers 
thus included are mostly severe remittents, taking the continued or typhus form. 
The fever begins with alternate feelings of heat and cold, and some remissions are observed 
in the first three or four days. In some cases it begins at once in the continued fever. If the 
patients are not properly treated death may occur in eight or nine days, but more frequently from 
nine to twenty days. The prominent symptoms are great oppression at the epigastrium, frequent 
pulse, the tongue coated with yellow fur, and delirium. Epistaxis occurs in about one in every 
ten cases. The rate of mortality, 'if the cases are properly treated,' should not be more than one 
or two in ten ; but as the patients often put off seeing a doctor till they ai'e seriously ill, the 
general mortality is perhaps 30 or 40 per cent. In reference to this form of fever Dr. Wong 
wrote : ' Doubtless other poisons besides malaria give rise to some of the malignant fevers seen 
here, and, in fact, in some of them quinine has no influence. Many of the fevers of the Chinese 
city must have their origin in overcrowding and bad sanitary conditions. These conditions, though 
sometimes regarded as harmless, because they have given rise to no epidemics of cholera, and 
as far as we know to no marked forms of typhoid fever, have much to do with the production of 
the severe fevers which prevail every summer. — (IV. 70.) 

In the Report for the half-year ending September, 1873, Dr. Wong wrote : ' During the whole 
time of the rain there was very little sickness, but as soon as the rain ceased and was succeeded 
by heat, numerous cases of fever appeared. — (VI. 48.) During the half-year ending September, 
1877, one case of typhoid fever, and one of serious hsemoi'rhage with fever, occurred among the 
foreign residents. Since 1873 numerous cases of the disease had occurred at this settlement. In 
most of these cases the duration of the disease was between thirty and forty days ; in one it extended to 
sixty-one days, but in the latter a relapse had taken place. The treatment pursued was by milk 



CONTINUED FEVERS, ETC. 101 

diet, and astringents when required. The Chinese do not suffer from it so often or so much as one 
would expect from the water they drink and the air they breathe. In some of the above cases 
there was but little diarrhoea, or it came on late in the disease and gave but little trouble. In 
others the ordinary symptoms were present, rose-spots, diarrhoea, tenderness and gurgling over 
the csecal region, rise of temperature and delirium. — (XIV. 57, 59.) 

In the period ending March, 1 878, fevers were prevalent. The type for the most part was inter- 
mittent, but some of the continued type was observed. In one instance, namely, that of a girl 
seven years old, there was a continued sensation of coldness and shivers ; the fever lasted three 
weeks, was unaccompanied by diarrhoea^ and was unaffected by quinine. — (XV. 13.) 

During the summer of 1879, a severe form of fever, presenting several characters of cholera, 
prevailed. In hospital, patients who had undergone operations manifested great liability to it; 
and although in many cases amenable to quinine, its sequelae were of a weakening 
nature. Later on in the season a peculiar form of remittent fever appeared. It 
affected the Chinese as well as foreigners. In the latter it occurred more particularly during conva- 
lescence from other diseases, as acute diarrhoea, dysentery, etc., but especially among parturient 
women. Almost every lying-in woman was attacked by it. It began without any marked chill 
or fever, but with nausea and severe headache. Within twenty-four hours the entire body was 
covered with a slight flush, the pulse and skin temperature being at no time much above the 
normal standard. Profuse perspiration followed. After this stage began, the fever recurred at 
intervals of four hours, but unaccompanied by the flush, nausea, or headache. Quinine seemed to 
have no effect, either in large or small doses. Dr. Oarrow found marked benefit from the use of 
dialysed iron and quassia. — (XVIII. 56.) 

In the half-year ending March, 1880, gastric and gastro-enteric fever occurred in children — 
not dependent upon the presence of intestinal worms. Exacerbations at noon daily ; there was 
little remission ; the symptoms were abdominal tenderness, constipation, flatulence j temperature, 
maximum, 103° Fahr. and 104° Pahr. ; tip and edges of tongue scarlet, its middle covered with 
yellow fur, showing papillse through its thickness. The affection yielded slowly to quinine and acid 
drinks, but showed a great tendency to become chronic. — (XIX. 16.) 

In the Report for the half-year ending 31st March, 1881, Dr. Carrow wrote : '1 can bear 
Dr. Manson out in stating that we meet with varieties of fever in South China which have not 
been described, and which do not fall under any classification heretofore made ; especially in this 
province. ' Fevers which yield to quinine, and fevers over which it has no influence,' seems to be 
a classification, although unsatisfactory, which one has to adopt in the treatment of these cases. 
At the present time I am treating two cases with quinine, and have had them under observation 
for two weeks, during which time I have kept up symptoms of cinchonism, and thus far have 
noticed no improvement whatever. In a recent case I gave up the quinine treatment, and a cure 
was speedily effected spontaneously.' — (XXI. 72.) 

In that for the eight months ending March, 1882, the same medical ofiicer writes on the 
subject of a type of fever which prevailed in Canton : ' An unusually severe form of remittent 
fever prevailed to a limited extent among foreigners. Two cases of recent date continued Be- 
have had to be sent to northern parts, after long-continued and large doses of mittent Fever, 
quinine, carbolic acid, etc., had been used without apparent effect. Dr. Carrow has noticed the 
more frequent occurrence of these severe forms of " continued remittent " fevers each succeeding 
year, especially with fevers which have a typhoid character. The cases have occurred, without 
a single exception, in people who have resided here for more than ten years ; while those who 
have but recently come always have it lightly. Patients perfectly strong and vigorous in other 



102 EPITOME OF MEDICAL REPORTS. 

respects are attacked without warniug^ and often without cause which they themselves can see ; 
and when this has been the case. Dr. Carrow has always had to order a change of climate, not 
having succeeded iu effecting anything more than a temporary cure by all the known remedies. 
He has noticed that after the first attack is experienced, the disease recurs regularly every 
year in January," February, or March. Those whose business brings them into the open air 
seem to be less liable to these climatic changes and diseases than those who lead sedentary, 
indoor lives.' He records the occurrence of one death by typhoid fever during the period 
in question.— (XXIII. 33.) 

In Japan only once during the ten-yearly period (18G2- 71) has typhus fever been epidemic — namely, 
at Yokohama, in 18G9-70. On that occasion the disease was almost limited to the shipping in the 
harbour, and to those recentlylanded therefrom — one single shijo furnishing 14percent- 
of all cases. Thus the disease appears to have been of the nature of what formerly was 
designated ship-fever, propagated by overcrowding and generally bad hygiene. Yet it spread 
to some extent epidemically among the natives. A few cases of the disease were noted in 187], 
and in 1877 a case occurred, clearly imported. In 18G9 the ratio of mortality of typhus to cases of 
the disease was 18'4 per cent. ; in 1870, it was 2G'2 ; in 1S71, it was o'oo ; for the whole ten years 
from 1868 to 1877 it was 25-0 per cent, of those attacked. Experience ait Yokohama indicates 
that since 1871 typhus fever has been very rare among natives, and altogether unknown among 
foreigners. The occurrence of typhoid fever appears to have moved almost jiari j^assu with typhus. 
Two cases were noted in 1S68, but in 1869 there were 31 admissions from this cause, or a percen- 
tage of irS of the total treated in hospital; in 1870 they were 15, or 4o per cent, of all : thus while 
typhoid was most severe in 18G9, typhus was most severe in 1870. Iu 1871 only 4 cases of 
typhoid, or 2 per cent, of the admissions, occurred, and after that date the disease almost dis- 
appears from the record. The next occasion on which a case appeared was in 1874 j in that 
year, 1875, and 1876, one case occurred in each; in 1877 two cases — all those from 1874 to that 
year among river residents. A large number of the typhoid cases were in non-residents, as 
were those of typhus at the same period; in 1869-70 eleven cases, or 24 per cent, of all the cases 
in that year, were from the steamer that on the same occasion yielded 1 !■ per cent, of the 
cases of typhus. This repoi-ter supposes that the preponderance of cases from, the shipping 
depended upon contaminated water-supply by drainage, and that the infrequency of the disease 
since 1871 is accounted for by the improvements that have been eiiected in these respects. 
During the same period of ten years the cases of simple continued fever which occurred are 
indicated as having been cases of 'abortive^ typhoid. Cerebrospinal meningitis : there is 
reason to believe from native reports that some years ago an epidemic of this disease prevailed 
in the country between Yokohama and Kioto some years ago, but no record of the disease having 
occurred in Yokohama itself or immediate neighbourhood exists. Relapsing fever, yellow fever, 
plague : these diseases are not known to have occurred in Japan. — (XV. 52, 53.) 

VI, PEEIODIC AND ' MIXED ' FEVEKS, AND ' MALAEIAL ' DISEASES. 

In the Report on Peking for the half-year ending September, 1871, Dr. Dudgeon wrote : 'By 

far the most common affection during the period under review was ague. It is usually the rarest 

.„ , . of diseases. Of all classes of disease seen at the hospital in 18G4 and 18G5, aarue 

Peking. ^ •" o 

formed each year only 1 per 1,000 ; in 18G0, 4 per 1,000 ; and in 1867, 
5 per 1,000, which was the highest rate during ten years. In the latter year there was an 
unusually large fall of rain in August and September.' — (III. 7.) In that capital, the former 



PERIODIC AND 'MIXED' FEVERS, AND ' MALARIAL ' DISEASES. 103 

rarity of ague was considered to be due to the light, sandy, and absorbent nature of the soil. But 
in 1871 cases of the disease were numerous, and in 1872 still more so. In the latter year it 
attained its maximum prevalence during autiimn, when the water began to abate, and when the 
effects of heat, moisture, and decaying vegetable matter were most pronounced. In the treatment 
of cases, the reporter states that the supply of quinine becoming soon exhausted, he had recourse 
to Powler^s solution. Cases also occurred now and then which seemed to resist the action of 
quinine, but gave way readily to arsenite of potass. He used with good effect a new preparation, 
namely, the carbazotate of ammonia, and found its action to be similar to that of quinine. Ague, 
which continued to prevail during the summer of 1872, gave way before the approach of winter. 
In the summer of 1873, ague was the most common disease in the capital. It had prevailed during 
the last three or four years in this district, owing, it was believed, to the great floods and inunda- 
tions. During the winter and spring months the disease was absent, but on the return of warm 
weather it broke out afresh. In July there were 377 patients with ague out of an aggregate of 
1,427, equal to 26 per cent.; but as ague patients generally recovered after one visit, or few 
returned again, the percentage ought to appear larger. In August, 45 per cent, of the new 
patients suffered from ague ; in September over 40 per cent. The cases of the disease came not 
only from the city, but also from the surrounding country. The disease did not stop with the 
approach of cold weather, as in former years, but prevailed with great virulence till the end of 
November, and did not decrease till late in December. The early cases had had few attacks. Those 
patients seen later on complained of having had attacks for two and three months. — (VI. 8, 14.) 

In the winter of 1873-74, ague prevailed with great force till the end of December. In that 
month there was a great falling off, as compared with the previous five months ; but not till 
January did a great diminution take place. Fowler's solution and quinine were extensively used. 
A few cases were met with in which quinine proved of little or no service, or if the symptoms were 
checked it was only to return in a few days. — (VIII. 29.) 

During the half-year ending September, 1874, ague prevailed to such an extent as to consti- 
tute an epidemic. In its treatment. Fowler's solution and quinine were both extensively used. 
The former is considered more active and certain, when continued for a few consecutive periods, 
than the latter. Dr. Dudgeon has met with a few foreigners and Chinese in whom the disease 
resisted quinine, but gave way readily to arsenical solution. In the Report to March, 1875, the 
statement occurs that ague was dying out, and hopes were entertained that after one or two dry 
seasons Peking might again become an unaguish district. — (IX. 21, 40.) 

At Tientsin, in the half-year ending March, 1873, the health of the foreign community was 
not affected by the inundation that had taken place in 1871-72. This immunity . 

. Tisnfcsm 

on their part was explained by the fact that the portion of the settlement occupied 

by them was elevated and well drained. The native Chinese, however, suffered much from fevers 

of a remittent and intermittent type. — (V. 24.) 

In the period to September, 1873, the tertian type of intermittent fever was that which most 
prevailed. The majority of cases yielded to small doses of quinine ; in a few, ai'senic, or bromide 
of potassium and strychnine had to be employed. At the same time a severe form of the ordinary 
marsh intermittent fever prevailed among the native inhabitants. It was very fatal, owing to 
dysentery setting in during convalescence. This form of fever was almost unknown here prior to 
the inundation of 1871, so that its origin is easily traced to the saturated condition of subsoil, 
owing to want of proper drainage. — (VI. 62.) 

In that to September, 1874, the quotidian type of intermittent fever was very prevalent, but 
with the exception of a few cases, was very amenable to treatment. — (VIII. 40.) 



104 EPITOME OF MEDICAL KEPORTS. 

Daring the half-year ending 30th September^ 1876, most of the cases of remittent fever 
which occurred were ' infantile remittent/ and were of mild type.' — (XXII. 48.) 

During the sis months to September, 1877, cases of remittent occurred with others of dysen- 
tery and bowel derangement. In the early part of the period, typhus, typhoid, and relapsing 
fever raged among the native population, and in August and September cholera. — (XIY. 66.) 

Malarial dysentery and ague prevailed during the first portion of the half-year to March, 1879. 
On the occurrence of the heavy autumnal rains they ceased. This impi'ovement was considered 
to be due to the circumstance that the marshy, grave-dotted plain at the back of the settlement 
became inundated, and the numerous large pits upon it filled with water. — (XVII. 34.) 

In the year ended March, 1880, notwithstanding that the general state of the public health 
was reported good, malarial disease, as diarrhoja, dysenteric attacks and interrnittents were the 
diseases which most prevailed. For the most part the type was slight. — (XIX, 5.) 

At Newchwang, in the summer of 1874, intermittent fever, for the first time, occurred. During 
the summer of 1873, and that of 1874, the rainfall had been excessive and unusual. The first 
case occurred in the person of a girl six years of age. She was attacked in June ; 
the type irregular. Very soon afterwards tertian intermittents became frequent, 
but the cases were amenable to treatment by Epsom salts, rhubarb, and quinine, although the 
health of the subjects of attack remained impaired for several weeks afterwards. The case of a 
native gentleman is alluded to in the Reports. Of nervous temperament, he had lived in 
Formosa, where malaria had been imbibed, and he suffered from ague and broken health. Soon 
after returning to China, he found that ' worry,' or fatigue, brought on a series of attacks of what 
the reporter thinks was ' dumb ague.' These attacks consisted of a chill, soon followed by headache, 
very slight but occasionally distinct fever, and ultimate recovery. As precautions, warm clothing 
was worn ; quinine was administered, but it was not tolerated ; iodide of potassium did no good, 
but arsenic and iron soon relieved, and eventually controlled the attacks. They recurred several 
times during winter and early spring, and in June and July the patient had regular attacks of 
tertian ague ; these were treated with arsenic. In reference to ' malaria •" generally. Dr. Watson 
writes in the same Report : ' The effects of malaria were various. In one family one-half the 
members would suffer from hemicrania, the other half remaining well. As " malaria has a trick 
of returning to a locality it has once visited," the medical officer urges the circumstance as a 
reason for improving the " sanitary conditions " of the settlement.' — (VIII. 8, 10.) 

At OhefoOj according to the Report for the period from October, 1871, to March, 1872, ague 
was unknown in the immediate neighbourhood ; but to the south and west of the province, where 
great plains allow the rains of summer to settle down in the soil, it is not uncom- 
mon. — (III. 40.) In the six months ending March, 1873, thirty cases of intermit- 
tent fever came under treatment. With three exceptions all had their origin in Japan, Amoy, 
or Swatow. Of the exceptions, two were sent from Shanghai, and one arose on the spot, in a 
patient who had suffered elsewhere from fever, two years previously. — (V. 18.) 

In the corresponding period to September, 1874, intermittent fever, mild in type, prevailed 
among the residents, in June, 1874, and chiefly affected children. It occurred in them during the 
period of dentition, and was accompanied in many cases by diarrhoea ; but the disease was in a 
great measure confined to families occupying inferior descriptions of houses. During the early 
part of summer there was a lai'ge influx of visitors from the south, affected with malarial remit- 
tent fever and intestinal catarrh. The former speedily yielded to change of climate. — (VIII. 50.) 

Dr. Oarmichael observes, in his Report for the year ending September, 1875, that fevers, 
dysentery and diarrhoea, so common and fatal in the south, are very seldom met with here. The 



PERIODIC AND ' MIXED ' FEVEKS, AND 'MALARIAL' DISEASES. 105 

prevalent fevers nre generally of the intermittent type, introduced for the most part from the south 
or from Tientsin, where they are considered to be due to inundations. Malaria, long dormant in 
the system, may become excited at Chefoo, from the cold and sudden change, after residence in 
a warmer and malarial climate. In some instances noticed, men had been free from the disease 
for months until they were exposed to cold and severe weather at this place. Such attacks are 
not generally repeated after small doses of quinine are given. — (XI. 2.) 

In the Report for the year ended September, 1876, Dr. Carmichael gives details of a case ' of 
one of the numerous forms of malarial fever which, after a cei-tain duration, assumes the continued 
type.^ The details aro headed, ' Remittent Fever with Enteric Symptoms.' It proved fatal, 
but no post-mortem examination was performed. The early history of the case contains the 

following particulars : J. S , aged 54, resident in China ten months. Never had any sickness 

at home, and was not troubled with any complaint in China until two months ago, when he was 
attacked with fever and ague. When taken ill, he was living at Woosung, in a Chinese house. 
After taking a course of quinine, the fever disappeared. Three friends with him were affected in 
the same manner. After this he removed to Hongkew. He was then affected with diarrhoea, 
and pain over the right side. This was shortly followed by dysentery, which lasted a week, and 
then again gave place to diarrhoea, which gradually diminished until he left for Chefoo. During 
the voyage he was ailing, and complained chiefly of thirst. When first seen on his arrival at 
Chefoo, on 27th August, he lay in bed; his expression was cadaverous; he stared in a stupid 
way, and did not appear to comprehend at once when questions were put to him ; he was restless ; 
his pulse 116; temperature 103'8° Fahr. ; the hands tremulous. His death occurred on 13th 
September.— (XII. 45.) 

According to the Report for the half-year ending September, 1878, no case of either remittent 
or intermittent fever occurred among residents during the previous twelve months ; ' in fact, 
Chefoo enjoys an immunity from these fevers.' — (XVI. 16.) 

At Chinkiang, during the year ended September, 1877, remittent and intermittent fevers 
were among the prevalent diseases. — (XIY. 63.) In that ended March, 1881, two 
cases of remittent came under notice, one of the number proving specially persistent. 
—(XXI. 99.) 

At Wuhu, in the half-year ended September, 1880, with the exception of five or six cases of 
intermittent fever, the Chinese who presented themselves for treatment suffered from diseases 
unconnected with ' malaria ' or with climate. Dr. Deane describes some of the cases _ , 

... Wuhu. 

seen as presenting ' slight and latent forms of malarial fever,' due to the position in 
which the dwelling-houses stand. The foreign residents from time to time Qomplained of malaise, 
gastric disturbance, diarrhoea, or constipation ; axillary temperature 1'5° to 3° above the normal ; 
general indisposition for work. — (XX. 22.) 

At Kiukiang, in 1871, there came under treatment 97 cases of tertian ague, 3 of ague in 
infants under three years old, 7 of tertian ague passing into the remittent, or continuous type. 
Two of these were opium-smokers, and their cases appear to be quite exceptional, 
as the use of the drug, among many evils, seems to secure one benefit, namely, 
immunity from intermittent fever. Several examples occurred in persons who had recently 
broken off the habit, ' but in this there is nothing surprising.' Irregular ague, 10 ; intermittent 
attacks of diarrhoea, 5 ; quartan ague, 17 — this form of the disease had lasted in several cases 
for periods of two or three years ; quotidian ague, 40. In three of the latter the attacks antici- 
pated, threatening to pass into remittent fever ; in three, the attacks were repeated twice or thrice 
a day {qaotidiana duplicata et triplicaia), and passed at length into a severe type of remittent 

14 



103 



EPITOME OF MEDICAL REPORTS. 



fever, wifcL continuous febrile action and slight remissions, but without distinguishable chills. 
Among the sequelas of intermittent fever were anaemia, fever with anasarca, chlorosis with mitral 
bruit, palpitation, pains in the limbs, debility, sallowness, and emaciation. In the majority of 
these the history of ague could not be made out, nor was there any palpable enlargement of the 
lirsr and spleen. The usual ferruginous preparations, with liberal dietary, sufficed in most cases 
to effect a rapid cure. In one or two cases of two years' standing, the mere substitution of 
animal food and bread for the insipid vegetable diet of the natives, together with change of 
residence, sufficed to produce a wonderful improvement. There were several cases of tertian 
ague and dysentery affecting the same patient, the prostration of strength and emaciation being 
very great. In these cases a combination of equal parts of quinine, bismuth, saccharated 
carbonate of iron, and Dover's powder, was most useful. In one case from a swampy district, 
enlarged spleen was present, and yet its subject denied having had ague. He suffered, however, 
from increased temperature, but seemed to be affected in no other way. A case of cancrum oris 
was recorded as a sequel to ague. While these fevers prevailed one case of continued fever 
occurred. It was attributed to cold ; its duration was seven days ; it was unaffected by sudorifics, 
purgatives, or quinine.— (II. G4, 65.) 

In the Report for the year 1872, cases of cancrum oris occurring in children are related. These 
are described as being due to malaria in and around this settlement. Cephalalgia and convulsions, 
apparently associated with exhaustion and aneemia, are also related. The pain assumed an inter- 
mittent character, but recovery took place under the use of quinine. — (IV. 45, 47.) During the 
year ended March, 1877, notwithstanding that the summer was mild, malarial fevers, together 
with dysentery and diarrhoea, prevailed. These were attributed to the flood by which for ten 
weeks the concession and low-lying districts around were deluged, their chief prevalence coin- 
ciding with the drying up of the waters. — (XIII. 1.) In the year to March, 1879, an unusual 
amount of sickness prevailed among foreigners, for which Dr. Jardine was unable to account. 
Among the diseases considered due to climatic causes, including ' the unusual length of the close, 
sultry weather, combined with the depressing influence of the flood,' were diarrhoea, fever, and 
many minor climatic ailments.— (XVII. o.) In the year ISSO, two priests arrived from the 
southern part of the province, where they had resided some years. The one suffered from 
chrome dysentery ; the other from extreme emaciation, debility, and almost imbecility, conse- 
quent on severe attacks of remittent fever.— (XIX. 1 0.) 

According to the Eeport to March, 1881, 'during the autumn of 1880, malarial fevers were 
very common, a large proportion of the community suffering from remittent or intermittent fever 
of severe and obstinate type; quinine in doses of 20 to :]0 grains alleviating somewhat, but 
failmg to " cure " the latter. The persons who suffered most were those who were in the habit, 
in the evenings, of bathing in the lakes after the water began to subside over flooded districts ; such 
cases were particularly obstinate. A larger number than usual of missionaries resident in the in- 
terior arrived at this settlement suffering from fever or dysentery. Besides a larger number of cases 
than usual of malarial fevers in the settlement, an increase took place in those treated for their 
sequelEe— chronic hypertrophy of the spleen, anasmia, and dropsy.'— (XXI. 48.) Throughout 
the year ended March, 1882, the 'more common diseases of this climate' were not unusually 
prevalent. In June, two cases of intermittent fever occurred ; they yielded readily to quinine 
but one of the patients had a recurrence of the disease before the end of the annual period' 
One case of severe remittent fever arrived from Ngankin ; it did well. According to accounts 
brought by missionaries, a severe form of remittent fever prevailed in the month of June at a 
village about 30 li east of Kiukiang. Of the patients who applied at the dispensary in the 



a 



PEKIODIC AND ' MIXED ' FEVERS, AND 'MALARIAL' DISEASES. 107 

settlement, nearly one-third of those who sought treatment on account of diseases of the eyes 
suffered from ulceration of the cornea. Many of the worst forms of that disease began while 
the patient was recovering from malarial fever ; indeed, the debility induced by intermittent and 
remittent fevers seems to be the starting-point of a large percentage of the cases seen here. 
Of the direct results of such fevers, antemia with enlargement of the spleen, and at times of the 
liver, are frequent, the latter not seldom further complicated with ascites. Cases of cancrum 
oris also occur as sequels',; and of them, only the minority do well under treatment. — 
(XXIII. 38, 39.) 

At Hankow, in the half-year ended September, 1871, fever was generally of the remittent 
type j its duration from a few days to several weeks, but leaving an amount of prostration out 
of proportion to the febrile symptoms. A case of adynamic fever occarred in a 
young woman engaged in tending native children. The nursery was situated on 
the ground-floor close to a badly kept drain. The girl had an attack of fever in May ; it 
reappeared in an intermittent form in June and July. In August, quinine having failed to check 
or moderate the disease. Dr. Reid first saw her. The malignant aspect which the fever had then 
assumed was by him attributed to impairment of the health by malaria, an impure atmosphere, 
and previous unsuitable employment. The patient died. In the case described, also, of a 
native missionary, the patient had for some time suffered from indications of fatty heart. He 
had a mild attack of fever, and suddenly expired during the evening exacerbation, the sudden 
collapse being explained by the depressing effect of malaria on an organ already crippled. A 
case is described in which febrile symptoms arising fi-om stricture of the urethra so closely 
resembled those due to paludal origin, that they were treated as if due to that cause. Malarial 
fevers prevail in September and October annually; also, after periodical inundations. They 
affect alike natives and foreigners. — (II. 47, 48.) 

In February, 1872, a rise of 20° Fahr. to 30° Fahr. in the maximum temperature took place, 
accompanied by a prevalence of malaroid disorders of the intermittent and remittent type. — 
(III. 43.) In the half-year ended September, 1872, a large number of cases of malarial fevers 
came from the surrounding districts. Chronic rheumatism, which prevailed extensively, was con- 
sidered to be due to malaria. — (IV. 74.) 

In the half-year ending September, 1874, fever and dysentery combined were frequent. In 
two of such cases, convalescence was interrupted by epistaxis. — (VIII. 48.) During the year 
ended September, 1875, 'malarial disorders' prevailed throughout the summer and autumn 
months. ' This can be easily explained by the usually accepted theory that malaria is a poison 
generated by the action of heat and moisture on decomposing matter in the soil.' Certain forms 
of suppurative hepatitis, dysentery, and malaroid fever have been the chief cause of serious 
illness among foreign residents here. — (X. 46.) During the year ending September, 1876, malarial 
disorders were prevalent. In reference to the existence of filthy pools in the locality, and offen- 
sive emanations therefrom, as possible causes of these diseases. Dr. Reid wrote : ' Although a 
marshy district and wet decaying organic matter are not the only necessary factors in the pro- 
duction of malaria, which is occasionally met with in a dry soil, and even in mountain regions at 
a height of several thousand feet, yet there can be no doubt that there is often a causative 
relation between them; for in numerous instances malaria has disappeared or diminished accord- 
ing to the drainage and cultivation of the soil, or even in correspondence with the dryness of the 
year.'— (XIV. 14.) During the year ending September, 1877, no example of severe malarial 
fever was met with among the foreign residents of this port. ' This may have been partly due to 
the dryness of the summer, the low state of the river, and the filling up of several of the low- 

14—2 



108 EPITOME OF MEDICAL REPORTS. 

lying lots.— (XIV. 79.) In that ending September, 1878, a few cases of dysentery and malarial 
and teat fever, of mild types, occurred among the shipping population ; a few of dysentery and 
of malarial fever among the foreign residents.— (XVI. 23.) During the half-year ending March, 
1881, remittent and intermittent fever were common, but only a few cases of any severity ; these 
were fatal. —(XXI. 45.) 

At Ichang, according to the Report on that place, for the six months ending September, 1880, 
'from the number of ague patients it will be inferred that the locality is not 
" ^^^' quite free from miasmatic poison ; but it is remarkable that, so far as Dr. 
McParlane was aware, no other fever was known to the natives of Ichang. — (XX. 20.) 

At Shanghai, according to the Report on that settlement for the half-year ended Sep- 
tember, the characters of the soil, as already described under the heading ' Topography ' 
(p. 29) qualifies the district as ' malarious,' the convenient term ' malaria' being 

MalS^a' ^^^^ *° designate the mass of describable and indescribable conditions which pre- 
vail in the neighbourhood of marshy lands, especially when these are subjected to 
powerful heat. From May till September, intermittent, remittent, and bilious fevers prevailed 
among foreign residents. The prevailing type of disease in Shanghai is periodic, and this type 
presents itself in the course of other diseases presumably not of malarious origin. The settlement 
is one of the homes of malarial fevers. But in cases of these diseases, the temperature curves were 
distorted by the intervention of quinine treatment; 'the patient and not the disease being in each 
instance the primary object of study.' In former years, the form of remittent fever here met 
with was of a dangerous and often fatal character, so much so, that it was known as ' Shanghai 
fever.' In the treatment of that form, ' quinine in any quantity often disagreed.' — (XL 33, 37.) 

In the period to March, 1872, the almost complete disappearance of the malignant, or at any 
rate extremely fatal, fever so named is noticed. Dr. Jamieson gives the following particulars in 
regard to it from a Report by Dr. Henderson, in 18G1, namely: 'Although primarily 
remittent, with daily exacerbations, its tendency is to become continued, in which 
form it differs but little from a severe case of typhus. It usually commences suddenly. The 
patient is seized with severe rigors, which last from half an hour to two hours ; then great heat, 
intense headache, flushing, and fever come on, followed by ]3rofuse perspiration. Occasionally 
the disease advances insidiously and gradually ; and its nature is only apparent after a certain 
period. In severe cases, during the cold stage, with other symptoms, the extremities are cold 
and livid; an intense feeling of cold pervades the whole body. Reaction ensues after a time : 
the skin becomes dry and pungently hot, the face is flushed and turgid, the pulse quick, full and 
bounding, the mind often wanders, with acute delirium. After a few hours, these symptoms 
subside, profuse perspiration occurs, the pulse falls in force and frequency, and the patient lies 
prostrate and exhausted. If the disease is neglected, the tongue becomes coated with brown dry 
fur, the liver becomes disordered ; there are bilious vomiting and diarrhoea, with tenderness and 
pain in the right hypochondria, rheumatic symptoms occur, purpurous spots appear, blood is 
discharged from the mucous membranes, great prostration ensues, and the patient dies coma- 
tose or delirious.' — (III. 78.) 

During the six months from September, 1872, numerous cases occurred of the malignant 
form of fever named after the locality itself, as already mentioned; and this circumstance is the 
more noticeable as the number of such cases had gone on diminishing during the few precedmg 
years. In one case related, the patient, aged thirty-five, had been subject to intermittent fever for 
many years. During two months the fever had assumed a remittent type, but yielded partially to 
quinine in large doses. A fortnight before observations commenced it became continued, with 



PERIODIC AND ' MIXED ' FEVERS, AND ' MALARIAL ' DISEASES. 109 

marked afternoon exacerbations, and delirium and sleeplessness at night. The patient was in the 
habit of taking quinine ' by the spoonful.' At noon on the first day of treatment, he was deeply 
cinchonized and muttering; there were besides constant starting of the tendons and occasional 
floccitation. He could be roused to consciousness, but did not care to recognise anybody. 
Temperature under the tongue, 107° Fahr. In the treatment of this case quinine having failed, 
turpentine was administered, but with such effects that the medical officer would not again give 
it. Finally the patient improved so much that he was put on board ship and despatched to 
England. At this settlement ' remittent ' fever is frequently intractable, and occasionally deadly. 
The medical officer calls it ' remittent,' although he is not quite sure what it is ; he thinks it is 
well referred to the class of mixed fevers. The absence of any sign of decomposition fifteen hours 
after death, under a temperature ranging from 83'5° to 86'5' excludes rapidly fatal typhus, and 
the fact that the patient was lodged in a tolerably cool room, and not exposed to the direct rays 
of the sun, excludes sunstroke. During the period in question, bilious diarrhoea, febricula 
from exposure to the sun, intermittent, and neuralgia, with other diseases usually assigned to 
' malaria,' were somewhat prevalent among the outdoor stafi^ of the Customs. — (IV. 94, 101.) 

In the half-year ending September, 1874, remittent fever of a typhoid character prevailed 
among adults and children, the former associated with more or less hepatic congestion. Inter- 
mittent fever was also common, but generally mild. Under the head of the prevailing diseases 
due to climatic causes. Dr. Jamieson includes hepatitis, dysentery, the malarial fevers, neuralgia, 
sun malaise, and dyspepsia due to hepatic congestion. In the same Report the medical officer 
gives particulars of three cases of typho-malarial fever as occurring at that settle- 
ment. The term, which he adopts from America, includes all those cases which ^^ Fe™-'™"^ 
lie on the borderland between remittent and typhoid, which would be considered 
remittent but for the marked typhoid symptoms, and for the less than doubtful efficacy of quinine; 
and which would be classed as typhoid but for the absence of eruption, and of iliac gurgling and 
tenderness. This class is therefore conterminous with the ' mixed fevers.' The 
type may at first be intermittent or remittent, but after a few days the disease 
becomes a true continued fever with delirium, which, alternately violent and muttering, may 
pass into coma, vigil, and death. There may be diarrhoea or constipation, but the evacuations 
almost always are extremely offensive. Fortunately, many of these cases recover. In reference 
to the first case recorded, the medical officer observes that ' Quinine had no effect in lowering the 
temperature.' In a second, ' quinine excited vomiting almost invariably.' In it, also, ' medical 
treatment was almost nil,' the chief trust being in amateur nursing. After the thirty-sixth day, con- 
valescence proceeded. In a third case he 'could attribute no benefit to the quinine administered,' 
unless ' that he fancied it controlled the epistaxis with which the patient, a girl of thirteen, was 
attacked.' In reference to the case thus noticed. Dr. Jamieson writes : 'The 

... -, n ... ,. ■,, ci_ Amateur Nursing. 

opportunity is a good one tor noticing the extraordinary excellence oi amateur 
nursing in Shanghai. Every practitioner must be struck not only by the readiness and devotion 
of the patient's friends so soon as the fatiguing duties of a nurse appear to call them, but by the 
skill and discretion with which they discharge the task they thus assume.' Several cases of 
remittent fever are then detailed in illustration of two distinct types of that disease to be met 
with at that place, namely, the uncomplicated and the complicated.^ (VIII. 16, 22, 23, 26.) 

During the period from October, 1875, to March, 1876, malarial fevers, chiefly intermittents, 
prevailed ; none of a very serious character. In one case, ' orchitis occurred immediately after a 
severe paroxysm of intermittent fever; it lasted five days, during which time there was no recur- 
rence of pyrexia, and on the sixth day suddenly disappeared, with the contemporaneous renewal 



no EPITOME OF MEDICAL REPOKTS. 

of the fever.' — (XI. 50.) In the six-monthly period ending Septembei', 187G, a severe case of 
quotidian intermittent occurred in a child two and a half years old. — (XII. 3.) 

In his Report to September, 1877, Dr. Jamieson notices a case in which the symptomatic fever 
in a case of orchitis simulated remittent fever. The case occurred in August, and in a person 
who had been on previous occasions the subject of malarious fever. The remark occurs, how- 
ever, that the remittent character of purely symptomatic fever often strikes one in surgical 
practice. — (XIV. 49.) In that to September, 1880, Dr. Jamieson wrote : ' The multiform modifi- 
cations imposed by acute or chronic malarial saturation on the natural course of specific diseases 
deserves careful study, as also do various independent typhoidal conditions hitherto undescribed, 
which occasionally end in death, and which are, in all probability, manifestations of acute 
malarial poisoning. To include them, the application of the term ' malaria ' may require to be 
widened so as to include the vehicles of poisons other than that, or those productive of the group 
of affections now classed as ' malarial.' — (XX. 33.) 

Under a different heading, namely, ' Trichina spiralis,' Dr. Manson also alludes to ' that cloak 
for ignorance we call malaria.' — (XXI. 36.) 

At Ningpo, in the half-year ending March, 187o, three cases of intermittent fever, and one of 
dysentery, represented all the ' malarial ' diseases met ^Yith. — (V. 25.) According to the Eeport 
for 1875-76, eight cases of intermittent fever occurred, all mild, and the majority 
iDgpo. tertian. They all speedily recovered under quinine. — (XI. 27.) In the year to 
March, 1877, ' intermittent fever was not so prevalent as in former years.' — (XIII. 47.) In that 
to March, 1879, intermittent fever had still further decreased, yet most complaints exhibited an 
intermittent character. — (XVII. 6.) 

In the Report for the eighteen months ending September, 1880, a description of the locality 
of Ningpo is given as already transcribed under the heading ' Topography ' of that place. In refer- 
ence to such conditions, Dr. Henderson writes : ' Here are the conditions favour- 
able to the development of malaria, and its protean forms are everywhere manifest 
— neuralgia, recurrent diarrhoea, enlargement of the spleen and liver, anaemia, subnormal tempera- 
ture, intermittent and remittent fever. Of ague is to be seen the quotidian, tertian and quartan 
types, but principally the tertian. During the preceding hot season fevers were very frequent, yet 
there was but little diarrhoea, and no dysentery. The form of fever which most prevailed was the 
remittent. All the forms met with were amenable to treatment. The mortality among the 
Chinese by these fevers is small. The lowest form of remittent may run on for months, under- 
mining the constitution, producing the pallid, washed-out, and miserable specimens of humanity 
everywhere to be seen around the settlement. During the rains there was no fever. In July, 
three cases appeared ; in August, eight ; and from thence the numbers increased at a rapidly 
accelerating ratio to the middle of October, involving nearly the whole community in its tide ; and, 
according to accounts received, proving fatal to a considerable number of Chinese. — (XX. 30, 31.) 
At Wenchow during the six months from October, 1877, to March, 1878, ague from country 
districts occasionally came under notice. — (XV. 40.) According to the Report to September, 1881 : 
Wenchow, situated on a reclaimed marsh, reticulated by canals, and almost on a level 
with their sluggish waters, is the abode of intermittent fever. Every spring, to 
some extent, and in autumn, that disease prevails, on occasions affecting half the inhabitants of a 
village. It is generally of mild type, except to new comers ; and they, after acclimatization, do 
not regard it with dread. The labouring poor, after being subject to attacks for years, cease to be 
so ; but then the anaemia and debility that ensue render them liable to other maladies, and so they 
are not long-lived. The quotidian and tertian types are light and amenable to treatment, disap- 



PERIODIC AND ' MIXED ' FEVERS, AND ' MALARIAL' DISEASES. Ill 

pearing on the advent of cold weather. Tertians, which are the most prevailing forms, some- 
times run into quartans, become chronic, resist all methods of treatment, and after a year or 
two terminate fatally. Adverting to the question of dependence of these forms of 
intermittent fever on the presence of rice-fields. Dr. Macgowan notices the circum- ^"'^-^«''^°- 
stance that the native inhabitants exonerate the rice-fields. Prom time immemorial the Chinese 
physicians have been aware of the value of arsenic in the treatment of ague, although they refrain 
from administering it internally. With regard to fever and ague and the state of the weather, 
they affirm that this disease prevails when a season is unusually windy. — (XXII. 22, 28.) 

At Foochow, in 1871, a considerable number of cases of intermittent fever occurred among the 
residents. Yet the land is high, the soil dry, consisting of red clay and disintegrated granite ; 
natural drainage perfect ; the dwellings of foreigners on dry elevated sites. It is 
observed that other causes than marsh miasm give rise to ague; among them, 
exposure to the sun, combined with hard physical and mental labour, tend to induce a paroxysm in 
all respects similar to malarial fever. Mental anxiety, and especially mental shockj will give rise to 
it without exposure. Ague occurs in countries and districts that are not marshy. The terms 
' malaria ' and ' malarious ' express rather our ignorance than our knowledge of the phenomena. — 
(IT. 2G.) 

In the six months to September, 1872, of the cases of intermittent fever that occurred, a large 
proportion were imported. One of the two local cases was attended by an urticarious rash not seen 
before by Dr. Somerville. He observes that the cases noted as sun malaise might perhaps have been 
placed under Tebricula;' but he has kept them apart in order to remark how similar many of 
these oases are to an ordinary attack of ague. The cold stage is represented by a chill experi- 
enced by the patient, and the rest of the case is almost identical with the second and third stages 
of ague. Further observations on this point are to be desired, as up to the present day our views 
as to the nature, and even the existence of malaria, are so undecided. With regard to the subject 
of ' mixed fevers,' the reporter observes that ' one form of fever passes into another, so that it is 
impossible for some time to ascertain the character of any assigned instance.' He quotes from Mr 
Lawson as to the complicated character of tropical fevers ; that cases may occur as intermittents 
after three or more tertian periods the fever become continued, assume all the characters of 
typhoid, present the appearance of the kidneys and urine met with in yellow fever, and end in 
death, the post-mortem appearances an intermixture of those peculiar to yellow and to typhoid 
fevers. A case in illustration is then related, and in regard to it the remark made that in China 
' cases are by no means uncommon where the liver and spleen are found extensively diseased after 
death, without having indicated during life symptoms other than those of functional disorder.' 
Dr. Somerville relates the case of the mate of a ship, where with symptoms of quotidian ague 
there was diarrhoea, then intense abdominal pain, delirium, collapse, and death. He looked upon 
that case as a mixed fever, either intermittent passing into typhoid and ending fatally by perfora- 
tion and peritonitis, or an ordinary intermittent assuming the ' pernicious ' type as described by 
Wood. Fortunately ' mixed fevers ' are rai'e at Foochow.^(IV. 58, 60.) 

In the Report for the half-year ending March, 1874, a case of malignant remittent fever was 
recorded. In it the patient seemed to be passing through an ordinary intermittent or remittent; 
presently slight confusion of ideas was observed ; in a few hours he was in pro- 
found coma with stertorous breathing, ' fly-catching,' convulsive jerking of the mtdE^iVeylv. 
muscles, and cyanosis. This form of fever presents several points of resemblance 
to the remittent fever of the Gold Coast, as described by Dr. Donnet. Dr. Somerville remarks 
that — ' Such expressions as " malarial influence," " paludal cachexia," and even " blood- 



112 EPITOME OF MEDICAL REPORTS. 

poisoning," are terms iiseil in tlie sense of expressing facts instead of mere hypothesio, tend 
rather to obscure than to clear up the etiology of the " mixed " and malignant forms of fever 
which are noticed there.' For the present, one thing seems certain, that quinine, so valuable 
in ordinary forms of malarial fever, is useless, if not positively hurtful, in those alluded to. — 
(VII. 10, 11.) 

During the six months ending September, 1877, cases of intermittent and of remittent fever 
■were very few, and all imported. In that period a case of mixed fever was recorded. It was com- 
plicated with severe double pneumonia, and was of so mixed a character that the reporter does not 
pretend to unravel it, and say what was remittent, what typhoid, and what pneumonia. The 
subject of the disease, a French sailor, died on the fifty-second day of illness, and no post-mortem 
examination took place. It is stated that quinine, given both in large and small doses, had no 
effect on the progress of the disease. — (XIV. 86, 87.) 

According to the Report to September, 1879, the malai-ial species of disease varies from per- 
nicious and remittent fevers down to ague in all its manifestations. Daring the period malarial 
fevers were of frequent occurrence. They were of all degrees of severity. What was known as 
pernicious fever, or congestive fever, was rare : when it happens, the reporter states that, ' Apart 
„ . . ^ from cholera, he does not know a disease, not organic, which so rapidly, and with 

Pernicious Fever. ' G ' r ." _ 

greater horror to the spectator, brings the patient within threat of instant dissolu- 
tion.' A gentleman ate a hearty breakfast, went about his work, began to feel chilly, an hour 
afterwards was comatose. A lady, previously in good health, about 2 p.ni. was seized with cold- 
ness and shivering, conjointly with pains in the limbs ; at 3 p.m. was lying in front of a large fire 
shi'ivelled as it were into herself, shrieking with cold and in intolerable agony in every bone; at 
3.30 p.m. she presented one dull leaden colour, her shrieks of pain, if possible, more piercing than 
before — she was thirsty, witli a thirst that nothing could slake ; at 4 p.m. she was comatose, and 
next to pulseless; at -5 p.m. a perceptible warmth set in ; at 7 p.m. in high fever; at 8 p.m. the 
fever abated, she awoke from her coma. She ultimately made a perfect recovery. It is further 
stated that — ' Remittent fever was first observed among foreigners about seven years previous. 
On different occasions, subsequently, an isolated case was noted ; the type in each very low, or 
what might be called typhoid remittent, but until the last year not fatal. Then, however, a case 
became complicated with pneumonia and proved fatal.' Further : ' Malarial rheumatism is 
Malarial Eheu- common. It occurs for the most part in a chronic form, and chiefly affecting the 
matism. right side — hence is liable to be mistaken for "liver." In persons under the 
influence of malarial poisoning, an attack occasionally supervenes after injuries, as a sprain or 
contusion.'— (XVIII. 0-5-07.) 

A topographical description of Foochow having been given in the Report for the year ending 
March, 1881, as already quoted under that heading {ante, p. 43), Dr. Rennie writes, in reference 
thereto : ' Having around us so abundantly all the acknowledged conditions necessary to the 
developnjent. of, the "bacillus malaria?," or whatever the germ of paroxysmal fevers may be, we 
need not be surprised at malarious diseases, as remittent fever, ague in all its forms, anaamia, and 
dyspepsia, being very prevalent among the natives.' These diseases affected, also, 35 per cent, of 
the residents. In all parts of the settlement, among houses situated on the highest points, as 
among houses built on sites a little above the plain, fevers were equally scattered. — (XXI. 50, 53.) 

In the half-year to March, 1882, the former prevalence of ileo-colitis seemed to have been 
supplanted by malarial fevers, the latter generally slight and fleeting, though protean in their 
forms, but sometimes severe, if rarely deadly. — (XXIII. 35.) 

At Amoy, during the half-year ending September, 1871, the majority of the diseases met with 



PERIODIC AND 'MIXED' FEVERS, AND ' MALA.RIAL ' DISEASES. 113 

were sucli as prevail in hot climates. The preponderance of climatic disease, however, was less 
marked than during any of the six preceding years, and this was to some extent accounted for 
by the unusual coolness of the season under notice. Of the cases of intermittent 
fever nearly all were of the quotidian type^ and mild in character. No case of remit- 
tent, or of bilious remittent, was recorded. — (II. 11.) Malarial diseases, when they do occur, are 
of less frequency in the cold season than during the summer. — (III. 22.) 

In the Eeporfc for the six months to September, 1873, the medical officer writes : 'It is 
seldom we meet with a genuine case of well-established ague in a European. This is for the 
reason that the approaching tendency to such an attack is treated by large doses 
of quinine, so that the regular attack when it does take place is aborted ; yet 
it is followed by an anaemia which hangs about the person for years.' He observes thus : ' We 
think that the stage of convalescence after this quinine-aborted fever to which Europeans are 
liable is much longer and more distressing than in the general run of well-developed a,nd perfect 
agues. The native expects his ague, lies down to it, goes through the three stages with 
equanimity, and rises up on the conclusion of his fever, ready for his work as if nothing had 
happened. Observing this, we sometimes think that there is such a thing as giving quinine too 
soon. The physicians of the last generation thought so. It seems to diffuse the disease, so to speak, 
as well as ultimately to cure it. We think its early use is the cause of a milder fever, but a more 
tedious convalescence.' Many agues come and go without leaving any prevalent bad effects. A 
patient in easy circumstances suffers less severely than one who is poor, and consequently without 
means of comfort. — (VI. 23.) 

The effect of emotions, such as fear, rage, etc., in preventing the development of an ague-fit 
is well known. That the ague of a Chinaman with his credulous and superstitious disposition 
should be very amenable to such influences, is what from his nature we should anticipate. An 
instance is given of a Chinaman subject to ague having come to a chapel of the London 
Missionary Society, so as to be ' under the protecting influence of the god of the chapel, that he 
might through his antagonism to the devil of ague avoid an impending fit.' Nor was the invalid 
disappointed J his belief had really made him whole. This chapel enjojed ^^^^^^^^^ ^^^.^^^^^^ 
a gi-eat reputation, many resorting to it for this purpose. In the same Eeport the 'Faith.' 
subject of anaemia is discussed. The medical officer observes that every attack of ague or 
other form of malarial fever is sure to be followed by more or less ansemia. The duration and 
intensity of this anaemia depend on the treatment adopted, the previous condition of the patient, 
and his food. A good deal of anasarca may exist in malarial anaemia, and this without the 
presence of disease of the kidneys or heart. Enlargement of the spleen is frequently present. 
Cases of enlarged spleen of malarial origin have been met with, however, in which there was no 
history of ague or other fever, but only of a life since childhood in a malarial district. But 
such cases are rare. Perhaps the most serious complication of enlarged spleen is ascites. With, 
or in the absence of, enlarged spleen, ulceration of the leg is a frequent accompaniment of 
malarial anaemia. An abrasion may ulcerate, or a pustule, or a sanguineo-purulent ulcer form on 
the skin, and even slough. The force of the cachexia may fall on the kidneys. In the district 
of Amoy the liver is seldom permanently affected as a consequence of ague. According to 
the reporter, malarial anasmia in early life retards development ; and he gives particulars of a 
case in illustration. Subjects of this form of dyscrasia are very liable to haemorrhages from the 
nose, gums, kidneys, etc., and from ulcers ; there is also a tendency to sudden collapse from 
coagulation of fibrine in the heart and large bloodvessels. In such cases, when a surgical 
'^ 15 



114 EPITOME OF MEDICAL REPORTS. 

operation becomes necessary, tlie patient should be prepared for it by means of a coarse of 
quinine and iron. — (VI. 23.) 

In the year ending September, 1879, several cases of malarial fever v?ere imported from 
Tamsui, but none of local origin among foreigners appeared, nor had the Chinese suifered 
during that season as much as usual from fevers. — (XVIII. 59.) In the autumn of 1881, 
within certain limits, a severe and often fatal form of remittent fever prevailed ; but the areas 
in which this was epidemic were very limited. The population as a whole was not implicated, 
and the disease did not attack any foreigners. — (XXIII. 17.) 

At Tamsui and Kelung, during the year ending March, 1874, a few slight cases of inter- 
mittent fever occurred ; they yielded readily to quinine. — (VII. 23.) In the six months to Sep- 

Tamsui nnd^ tcmber, 1877, a considerable number of cases of malarious fever occurred, chiefly of 
" '"'^' a remittent and intermittent type. At Coal Harbour, several cases of the former type 
occurred among the mining experts employed there, the men so attacked being Europeans 
arrived from France and England during the two previous years. — (XIV. 82.) 

According to the Report to September, 1878, malarial fevers ranked high in the list of pre- 
vailing diseases. The type of remittent and intermittent fevers as presented in some cases was 
very severe. In one case the occurrence of severe muscular contractions (convulsions) in the 
course of the cold stage is recorded. Daring the convalescence of the patient a severe crop of 
boils occurred. In one of remittent fever, quinine having had no beneficial effect, the patient was 
removed by steamer to Amoy, and seemed to be restored to health by the change. — (XVI. 18.) 

During the summer of 1879, there was as usual a considerable amount of malarious fever, 
almost all the residents having suffered more or less from intermittent or remittent fever. — 
(XVIII. 64.) 

In the summer of 1880, malarious fevers were also somewhat troublesome. Dr. Einger 
stated that he has had frequent opportunities of observing that foreign residents in localities 
where so-called malarious influences exist may ward off their deleterious effects for a considerable 
period, even for years, but may suddenly, although being apparently under precisely similar 
circumstances, be seized with an attack of ague or remittent fever, and with no other cause that 
one can discover than perhaps a slight chill or a very brief exposure to the sun, such as would 
usually be passed by without a thought, and in some cases absolutely nothing out of the ordinary 
routine of daily life can be called to mind by the patient to account for the attack. ' Once a 
patient has suffered severely from remittent or intermittent fever, it requires as a rule but a 
slight cause, such as getting wet, or being exposed to the sun for but a short time, to start the 
blood poison, as it may be expressed, and produce another attack. But,' it is added, ' our 
knowledge of the pathology of malarious diseases is at present somewhat imperfect.' — 
(XX. 16.) 

At Takow and Taiwan-foo, according to the Report for the half-year ending September, 1871, 

intermittent fever and malarial neuralgia occurred among the residents. In the former quinine 

was successful, in the latter not so, but arsenic produced better results. In cases 

Tdwrn-foo. 0^ remittent fever great and sudden prostration occurred, also low delirium and 
bleeding from the fauces. Enlarged spleen is common, associated with anasmia 
and ulcers on the legs, the left more liable to these than the right. These cases are benefited by 
the use of iron. Goitre also is present in the lower range of hills. — (II. 68.) 

During the period to March, 1872, a few cases of ague and two of remittent fever occurred in 
the settlement. Among the natives, malarial fevers were the chief causes of death. These pre- 
vailed mostly from Augusb to iSfovember inclusive, and least in February and March. A number 



PEETODIC AND 'MIXED FEVEES, AND ' MALAEIAL ' DISEASES. 115 

of cases of this kind came from Lambay, a small rocky island lying about ten miles south from 
Takow, and separated from the mainland of Formosa by about six miles of sea. The reporter 
observes that, judging from its physical character, Lambay ought to be the reverse of what 
is usually considered malarious; yet malarious fevers are exceedingly prevalent there. — 
(III. 34.) 

Coincident with a heavy rainfall in May, 1872, a severe outbreak of intermittent and remittent 
fever took place among the Chinese population ; among the shipping also these aSections 
were numerous. Malarial fever, prevalent more or less during the whole year, became epidemic 
after May throughout the summer. The mortality in the country districts was reported to be 
very great, particularly so at Pitau, a large town six miles inland from Takow. The more severe 
forms of the prevailing fever seen were characterized by adynamic symptoms, little or no 
remission, and a tendency to dysentery during convalescence. In two fatal cases hemorrhage 
occurred from the stomach and bowels. Two cases of death occurred by rupture of enlarged 
spleen.— (IV. 24, 26.) 

In the Report to March, 1873, the falling off in the number of applicants for treatment among 
the Chinese is attributed to the fact that malarial disease is less prevalent in winter than in 
summer ; also the natives have an objection to leave their homes in winter. As on the previous 
occasion, so now, during the months from June till October, the prevailing type of fever was 
remittent and adynamic, with a tendency to dysentery during convalescence. — (V. 26.) 

In the period to September, 1873, the circumstance was noticed that intermittent fever 
specially prevailed in one particular house of a European resident, situated on a site surrounded 
by water. Again, among natives, malarious fevers were among the principal causes of death, — 
(VI. 38, 40.) 

In the period to September, 1874, the boatmen occupying 'official' residences suffered 
severely from intermittent fever, followed by much debility and protracted convalescence, with 
gastric and spleen derangements. The locality in which these residences were situated had 
acquired the reputation of being extremely unhealthy. Among the Chinese inhabitants inter- 
mittent and remittent fevers were very prevalent, although Chinese troops, encamped six miles 
inland, enjoyed good health. — (VIII. 12, 14.) 

In the six months to March, 1876, several of the community suffered from simple attacks of 
intermittent fever. These were chiefly the occupants of a locality for some time admitted to be 
malarious. Among other affections assigned to the same cause were enlargement of the spleen, 
irritable ulcers on the legs appearing with each attack of fever, great depression bodily and 
mentally. About the beginning of October, when the country was drying up after the rains, 
malarious fever assumed an epidemic form, and was more fatal than it had been for some years. 
— (XI. 34.) 

In the year to March, 1878, as effects of malarial poisoning among the foreign residents, 
intermittent and ' pernicious ' fevers, with severe and dangerous symptoms, occurred. In one case 
malarial fever was associated with rheumatism. And yet, as the rainfall, although considerable, 
was nearly all absorbed by the parched soil, the elements usually believed to be the cause of 
malarial diseases could not have been developed. No cases of such diseases occurred during the 
months of December, January, and February. — (XV. 36.) 

In his Report for the half-year ending March, 1882, Dr. Myers writes : ' The most prominent 
ailment at those places is fever, evidently of malarious origin, but the peculiarity of its typo 
attracts special attention. He does not know that he has ever seen a case of what is commonly- 
understood by fever and ague, pure and simple, arise in the Taiwan-foo settlement. On the 

15—2 



116 EPITOME OF MEDICAL REPORTS. 

contrary, the disease common there is distinctly of the typho-malarial, or mixed-fever class; 
indeed, were it not for the marked intermissions, so prominent are many of the typhoid symptoms, 

inclnding spots, iliac gurgling, intense depression, etc., that one seeing a case for 
^^MKrcTS" tlie first time would be very apt to call it typhoid, and to have his fears excited 

to a greater extent than is always called for. As a remarkable proof of the 
peculiar local influences in relation to the characteristic disease of the place, in the north-east 
monsoon, when the prevailing winds are more or less off the land, persons on board ships lying 
in the roads, who have had no contact whatever with the shore, and to whom no shore-water has 
been supplied, are often stricken with this Taiwan-foo fever, and in their case the consequences 
are much more grave than those observed among regular residents. In fact, by far the greater 
number of cases on board ship, coming under the notice of Dr. Myers, occur in the vessels lying 
off Anping.— (XXXIII. 28.) 

At Swatow, in the half-year ending September, 1871, zymotic diseases stand at the head of 
prevailing affections through that period ; and at the head of that class stands intermittent 

fever. — (II. 7.) During the period to September, 1874, the disease most frequently 

met with was remittent fever. ' Almost every European suffers from it at some 
time, but fortunately it is of a very mild type.^ In the treatment of this form. Dr. Scott has been 
in the habit of giving quinine with blue pill ; after long experience he has found small doses of 
mercury to be most useful in such cases. Intermittent fever is almost unknown here. — (VIII. 65.) 
According to the Report for the period to September, 1876, intermittent fever was common 
among sailors who slept on the decks of ships with little covering, or who were in the habit of 
bathing under a hot sun ; otherwise it was rare. — (XII. 19.) During the period to March, 1877, 
there was a falling off in malarial diseases. — (XIII. 9.) In that to September of the same year, 
the majority of diseases met with among residents belonged to the miasmatical class. — (XIV. 68.) 
Some severe cases of miasmatic diseases occurred in October and November. — (XV. 23.) In the 
half-year to September, 1879, there was not more than the usual amount of summer diarrhoea 
and intermittent fever. Some severe cases of fever and dysentery occurred among resident 
children, two of which were fatal. The peculiar form of fever which occurred among them is 
already described under the heading ' Continued Fevers.' — (XVIII. 75.) 

At Canton, during the half-year to September, 1871, the fevers from which foreigners suffered 
were all of the intermittent type ; among the Chinese of the city, however, remittent fevers were 

somewhat frequent, sometimes of virulent character, some of an intractable nature. 

— (II. 70.) In that to March, 1872, the cases of intermittent fever were all of the 
quotidian type. In many of them diarrhoea was present at the same time. The association of 
diarrhoea with fever is often met with among the Chinese as well as in foreigners. — (III. 19.) In 
the period to September, 1877, cases of intermittent fever were comparatively few, but dian-hoea 
was rather common ; so also were cases of subacute hepatitis. — (XIV. 57.) In August and Septem- 
,. ^ ber, 1879, a peculiar form of remittent fever appeared. It affected both Chinese and 

Pcculmr Fever. . . . , - . . 

foreigners. With regard to the latter, ifc did so more especially during convalescence 
from other diseases, as diarrhoea and dysentery ; also after parturition. The attack began with 
nausea and headache, but without chill or heat. Within twenty-four hours the body became 
suffused with a slight flush, the pulse and temperature at no time much above the normal 
standard. Very profuse perspiration soon succeeded. After this stage set in it recurred at 
intervals of four hours, but unattended by flush, nausea, or headache. Qainine had no effect in 
large or in small doses ; in one case where its use was discontinued after the patient had been in 
a state of cinchouism for seven days, improvement began under the use of dialyzed iron and 



PERIODIC AND ' MIXED ' FEVERS, AND ' MALARIAL ' DISEASES. 117 

quassia. The summer was ' exceptionally free from the ordinary complaints which we naturally 
expect in this climate.' — (XVIII. 56^ 57.) 

At Hoihow during the half-year ending March, 1882, deaths were reported as being numerous 
by malarial fever among the Chinese troops sent to quell the disturbances then 

, Hoihow. 

occurrmg m the north of the island of Hainan. — (XXIII. 31.) 

In the hospital records at Yokohama, up to 1876, only 20 cases of malarial diseases were 
shown. Of these, 2, or 10 per cent., occurred in residents, and 18, or 90 per cent., in non- 
residents. From 1875 to 1877 there were recorded 31 cases, including 14 cases 
of malarial cachexia; the majority of these from a man-of-war arrived from malarial 
regions beyond the limits of Japan. Of the 31 cases, only 5, or 16'1 per cent., were of residents. 
It is shown that in the same period there was a small increase in cases of the more acute 
forms of ' malarial poisoning.' Of 51 cases of malarial disease admitted in ten years into 

hospital, only 1 proved fatal. Malarial influences are manifest at Yokohama in an irregular and 
often puzzling manner. Typical cases of remittent and intermittent fevers are infrequent; while 
periodic neuralgia, dumb ague, and other forms of malarial poisoning, are common. The severe 
congestive form of malarial fever is rare, and seldom so violent in nature as to be properly 
classed as malignant or pernicious. A few cases resembling the typho- malarial fever of Wood- 
ward have been met with. 

An increase in the prevalence of malarial afEections was observed after 1871, in which year 
improvements in the sewage, drainage, etc., of Yokohama, with consequent disturbance of the 
soil, began to be carried out. Daring the re-excavation of the canal, in the spring and summer 
of 1877, a marked increase in malarial disease was noticed in the neighbourhood of the works. 
It was therefore considered probable that while the drainage and levelling of the settlement had 
diminished the frequency of 'typhoid' fever, it had increased the number of malarial troubles. 
All seasons seem almost equally favourable to the development of malarial affections ; and the 
forms in which they appear are very various. Many such cases appear in midwinter ; moreover, 
certain portions of the elevated and airy Bluff are- as subject to malaria as is the level and low- 
lying settlement. — (XV, 53.) 

VII. SOME CHINESE VIEWS EEGAEDINO FEVEKS. 

Chinese annals contain many notices of fevers, observations on which have come down from 
proto-historic times. A Chinese medical work, entitled an ' Essay on Epidemics,' discloses the 
curious fact that, according to its author, physicians in China for 1,400 years had proceeded on 
a wrong course in the treatment of epidemic fevers, which caused a frightful loss of life during 
all that period. The work in question is from the pen of Wu Yuhsin, a physician of Soochow. 
It was written in 1641, and published in 1852. According to Dr. Wu, from the time of Tsin, 
A.D. 265, down to his own day, erroneous views in regard to the etiology of epidemic fevers had 
prevailed; namely, that, like ordinary continuous fever, they were caused by vicissitudes of the 
seasons, instead of ascribing them to a sjiecifio poison. At the time he wrote, a fearful epidemic 
prevailed over four provinces of the empire ; but he affirmed that the mortality was not due to 
the pestilence, but to the wrong treatment to which the patients were submitted. It is observed, 
however, that the earliest known Chinese work on fever dates from the period from B.C. 200 to 
A.D. 200. According to native theory, ' morbific cold' is a generic term for fever. The cold of 
winter engenders the miasm, which enters the pores of the skin ; it is non-contagious, and pre- 
vails every year ; while the ' poison' of epidemic fevers is taken in at the mouth and nostrils. 



118 EPITOME OF MEDICAL REPORTS. 

and is communicable. In the former, sudoriflcs are indicated ; in the latter, discutients. ' This 
contemporary of Harvey says: 'Of three men encountering malaria, one whose stomach is empty 
will sicken and die ; the other, who has imbibed spirits, will suffer a disease ; while the third, 
who has well breakfasted, escapes unscathed.' — (XXII, 23.) 

At Peking the popular name for ague is yau-tse, the book name nio-chi, from its resemblance in 
its treatment of people to a harsh and cruel man. Several kinds of ague are specified in Chinese 
medical works. The principal are the following, ranged according to their causes : wind, cold, 
heat, damp, phlegm, food, excessive exertion of body or mind, spirits (devils), epidemic, pesti- 
lential vapours issuing from deep valleys, and old ague. The latter is caused by phlegm, water, 
and bad blood getting coagulated into one lump, which is buried in the body, and which becomes 
enlarged and painful. This kind is well known as mother ague. The kind called hwei or hsieh is 
caused by a person, especially from a distance, sleeping or watching in a room with a corpse. 
He is afterwards seized with cold and hot attacks, and has bad dreams. 

The symptoms of ague are minutely and very correctly described in all Chinese medical books 
from B.C. 2600 down to the present dynasty. The cause of the cold and hot stages is traced to 
a want of harmony between the two principles in nature, the ijiiv and the yang. The former 
represents the cold, the latter the hot period. In the one case the yang is conquered, and the yin 
prevails, which ushers in the shivering stage ; the two principles meet again, and this time on the 
outside of tlie body, and fighting again ensues, when the yang conquers or prevails over the yin. 
When the yang is very weak, the cold period is intense, and the very bones become painful. 
When the yin is weak, there is great external and internal heat, and thirst ensues, with quick 
breathing. In the yin stage the pulse is slow ; when the yang comes the pulse is quick. If the 
pulse be short, it has been injured by food ; if slippery, it has been caused by two much phlegm. 
-(III. 7, 8.) 

In the Report on Amoy, for the half year from April to September, 1873, Dr. Manson dis- 
cusses Chinese theories of ague. He observes that they have many names for that disease. The 
proper name is Kao-jiet-pi, cold hot disease ; other names are TJl-ueng, the creeping cold ; Khit- 
chia-j)!, the beggar's disease, so called because the shivers of the disease resemble those of the 
ragged beggar; Ta-pai ; 8am-ning-in, meaning dishevelled hair, as applied to a devil ; Lung-han, 
cold wound, etc. Many ague patients do not like to be asked if they have the Kao-jiet-pi ; they 
think the mention of the word is sufficient to call the devil. The reporter has heard of cases in 
which the simple mentioning of the name has induced an attack — they prefer to give the disease 
a bad name, as beggar's disease, devil's disease, or the two-days'-one-time disease, etc., believing 
that the devil will not care to answer or come when he gets a disrespectful appellation. — 
(VI. 23.) 

In the treatment of fevers the Chinese physicians in some instances employ diaphoretics, 
diuretics, and sometimes aperients ; ia others, ' medicines that subdue fever without diaphoretic 
action.' In adynamic cases they give restoratives. But in diet the patient is limited to yam, and 
a kind of squash called tung-lwa. In 'spotted' fever the chest is rubbed with betel-nut until 
spots appear; these spots are then pricked or separated, so as to eliminate the foison from the 
system. These measures give a fair amount of success — so much so that the prospect is con- 
sidered remote of the Chinese abandoning their system for the European method of treating 
fevers. It is observed that quinine is the only febrifuge we possess which has a decided 
superiority over the drugs of the Chinese. They can, however, generally cure intermittent fevers 
with their own drugs, so that the superiority of quinine is not very marked in their eyes. In in- 
termittent fevers of a paroxysmal character the Chinese also effect many cures, namely 80 per 



SOME CHINESK VIEWS EEGARDING EEVEKS. 119 

cent., if tie patients are treated sufficiently early. Dr. Wong says : ' Quinine can do more than 
this.-" The difficulty of the Chinese, however, is chiefly felt in those fevers of a continued or 
typhus type, or presenting a malignant character ; but as in such cases quinine often can make 
but little impression, other European medicines possessing no specific power over fever cannot 
appear to decided advantage. — (lY. 71.) 

The forms of ague recognised in Chinese works on medicine include a cold stage and a hot 
stage ; the latter due to the moist heat of summer opening the pores of the skin, the former to 
checked perspiration by wet weather. The cold is the result of the yin vapour or air, and the 
wind is the yang air. The second form, first hot, then cold, is just the reverse, and is explained 
in a similar manner to the above. Another form described is the hot stage without any cold j 
here there is the total absence of the yiii, and the presence of the yang air only. From its being 
hot only this form is called shan ague. 

Among native remedies used by the Chinese in the treatment of ague ' during the last 3,000 
years,' a few examples occur in the Report, namely : 

1. 15.. Cinnamon, ]| mace. 

Fang-feng (rad. Libanotidis), 11- mace. 
Liquorice, I J- mace. 

Infuse. 

This is the most common method of administering drugs in China, This remedy is useful in 
cases of perspiration. 

2. In cases where perspiration is absent : 

1^. No. 1, with the addition of Ma-hivang (ephedra). 

3. In the daily form, and cold and hot alternately : 

]J. C'hai-ha (rad. Bupleuri octoradiati), 2 mace. 
Kwei-chih (cinnamon), 1 mace. 
Hwang-chin (rad. Scutellariae viscidulee), 1 mace. 
Ginseng (Panax quinquefolia ?), 1 mace. 
Shwoh-Yueh (rad. Pfeouia albiflorge), 1 mace. 
Pan-hsia (i-ad. Ari macrori), 1 mace. 
Liquorice, 5 candareens. 
G-inger, 3 slices. 
Jujubes, 2. 

The treatment for day attacks and for night attacks of ague is different. One remedy is the 
following ; if it should prove too hot to take, a little camphor is to be added : 

4. 5;. Ti-lung (Lumbricus). 

Ginger, peppermint, honey, water, q. s. 

Another prescription is tortoise-shell reduced to powder. A third is composed of centipedes ; 
a fourth of the skull of a tiger ; a fifth of the excrement of foxes j a sixth of the flesh of a fox, 
and so on. 

A recipe of repute for mother ague, i.e., when there is great enlargement of the abdomen 

(spleen ?), is — ■ 



]20 EPITOME OF MEDICAL REPORTS. 

5. J^. Assafoetidaj 2| mace. 

Hsiung-hwang (realgar), 2| mace. 
Vermilion, I5 mace. 
The assafoetida to be boiled, and the other ingredients to be afterwards rubbed up in it. 

Several celebrated ague recipes are styled the Barrier Prescrijitiouft, because they cut short the 
attack and cure the patient for ever, thus rendering a future attack impossible. The medicine re- 
quires to be taken once only, and the action resembles a divine method. 

6. IJ. Gh'ang -shun (rad. Lysimachite), 1^,- mace. 

Ping-lancj (betel- nut), 1 mace. 
Cloves, i mace. 
Wu-viei (black plum), 1. 
Spirit, 1 cup. 
Infuse. The mixture to be taken warm on the morning of the day of attack. 

This recipe is highly spoken of. It is given as a tonic, this class of medicines being considered 
very efficacious. Ginseng is recommended extensively in a series of prescriptions, and comes next 
to cinnamon in the order of frequency. 

There are also magical remedies laid down, of which the following are examples : 

7. On the Bast, place patow (Semina crotonis tiglii). 
On the South, cassia. 
On the Middle, hsiung-hwang. 
On the West, alum, 
On the North, Ch'-ing-tai (indigo). 
Of each, 3 mace. 

On the 5th day of 5th month, prepare the above prescription ; put each of the ingredients on 
a separate tray, taking care to prevent cats, dogs, and women from looking upon them. At noon, 
got five glutinous rice-puddings (they are triangular in form) from friends, remove the spices from 
the cakes and knead them together, rubbing up the medicines with them. Prom this jDill-mass 
make pills the size of small marbles, and let the ague patient take one, thinly enveloped in cotton- 
wool, early on the day of attack, and introduce it, if a male patient, into the left nostril, if a female, 
into the right, and abstain from all food and drink. 

To cut ague short in ' spirit-like manner,' the following is strongly recommended : 

8. I^. Arsenic, 2 mace. 
Large spiders, 3. 
Round black beans, 49. 

Rub them all up and make into pills, the size of small buttons j and on the night before 
the fit occurs, take one pill under the star called Peitow. And on the following morning wrap up 
one in cotton-wool, and if a male person, put it into the left ear ; if a female, into the right, and 
the patient will immediately recover. One of these pills will infallibly cure two individuals. 

The reporter writes : ' It is thus somewhat remarkable that the Chinese should have been 
following for several thousands of years, among others, a tonic and arsenical treatment. The 
confidence with which the drugs are given would indicate, unless their whole system from 
beginning to end is quackery, that their experience must have taught them the efficiency of many 



SOME CHINESE VIEWS REGARDING FEVERS. 121 

of them. The names by which the prescriptions are known are sometimes very high-flown, such 
aSj " The great, instantaneous, god-like, infallible, speedy, sure, once-to-be-taken ague remedy." ' 
He observes that he himself has no experience of any of the native remedies, but the fact that so 
many patients come to us for treatment seems to cast doubt on the eiRcacy of the native 
nostrums. — (VI. 15.) 

At Kiukiang, in 1871, the treatment approved by the native faculty for the cases of compli- 
cated intermittent fevers which occur at that place, consisted in the wearing of a 
solid ring of silver round the neck. — (II. 65.) 



VIII. HEAT-MALAISE AND HEAT-APOPLEXY. 

At Peking, 1871, many Chinese in summer expose their heads to the most violent sunshine 
without the slightest danger, or protect themselves with only a handkerchief or a 
fan. Sunstroke, or heat-apoplexy, is almost unknown in Peking. No cases have 
occurred among foreigners. — (II. 80.) 

At Kiukiang, in the period to September, 1872, one case of solar or heat-apoplexy occurred in a 
sailor on board H.M.S. Severn ; recovery took place in it. — (IV. 44.) In 1879, a fatal case occurred 
on board H.M.S. Midge. It took place on 22nd July, at about 3.45 p.m., in a man 
who had not enjoyed good health previously, and whose habits were not unfavour- 
ably reported. He had been at church on shore that morning. The temperature in the shade, 
93° Fahr. ; the day very sultry and oppressive. — (XVII. 1.) In August, 1881, there was a case 
of cerebral congestion, induced by heat, in a child eighteen months old. Though at one time in a 
critical condition, he made a good recovery. — (XXIII. 38.) 

In the Report on Hankow to 30th September, 1873, particulars are given of two cases of 
insolation, both having occurred in foreigners at that port. Among them the affection is rare ; 
so also is it among the natives, notwithstanding that the latter go through 
severe physical exertion, and with their heads unprotected from the sun. Both 
the cases alluded to occurred on board H.M.S. Ringdove. Neither of the men had been exposed 
to the direct rays of the sun. In one the symptoms began towards midnight, in the other towards 
morning. The temperature at the time of their occurrence ranged in the shade to a maxi- 
mum of 85° and 88° Fahr.; wet bulb, 83° and 84° Fahr. j vacuum solar at noon, 161° and 
166° Fahr. In both cases the stupor was complete; the temperature of the skin, 108° Fahr. 
Besides the ordinary symptoms, frequency of micturition was a marked indication in one. 
Recovery took place in both, but more slowly in one than in the other. The treatment in both 
consisted of the douche applied to the head and spine by means of the ship's hose, purging 
enemata, and blisters to the nape. With regard to the etiology of insolation, two sets of views 
are quoted. According to one, the phenomena depend upon a diminished action of the 
emunctories during intense heat, and the poisonous effect of the retained excreta on the nervous 
system; according to the other, to enfeeblement of the sympathetic, leading to vasa motor 
paresis.' — (VI. 33.) 

In 1 875, the first week in August was extremely sultry, oppressive, and still. On 6th, at 
4 p.m., the maximum thermometer indicated 96° Fahr. ; wet bulb, max., 85° Fahr. ; black bulb, 
in sun, 152° Fahr. ; min. on grass, 95° Fahr. During that day three cases of sunstroke occurred 
on board the gunboat in port. One patient speedily died ; the other two recovered slowly under 
the use of affusion by means of a hose. Orders were issued on board that men who ceased to 

16 



122 EPITOME OF MEDIC A.L RErORTS. 

perspire, or were affected witli frequent micturition, sliould report themselves at once for treat- 
ment. Seven men had to be landed on account of febrile symptoms. — (X. 47.) 

In the Report for the year ending 30th September, 1S7G, it is recorded that, the air tem- 
perature being 97" Fahr., a foreigner, aged 50, on board a small steamer, vs'as attacked with and 
died of sunstroke. His skin temperature was 110° Fahr. After the use of the douche, it foil 
to 100° Fahr., but the patient quickly sank. Adverting to the hypodermic injection of quinino 
and subsequent recovery in such cases, Dr. I\-eid observes that it did not take place more rapidly 
than in similar cases after the use of the douche. — (XII. 15.) 

In that for the year to September, 1878, a case of sunstroke from direct exposure is related. 
The'subject of the seizure went out canoeing at 3 p.m., on an intensely hot day, and with a straw 
hat on. At 5 p.m. he returned exhausted, vomited, had severe headache and feverishness. Next 
day, to these symptoms he had frequent urination. Ho ultimately recovered. It is noted that 
he was of temperate habits and good physique. — (XVI. 23.) 

At Shanghai, according to the Report for the six months to September, 1872, few, if any, 

Chinese die from the direct rays of the sun. Though for some days in every summer the tem- 

, . perature rises to or above 100' Fahr., yet we have never to clironiclo results 

Shanghai. '^^ , ■' 

similar to those which follow a like temperatiu-o in other parts of the world. With 
hardly an exception, the deaths from heat-apoplexy miglit with moro correctness be chissified as 
from drink poisoning. Dr. Jamiesou considers that the mnrbu-^ siil.slitinlis of I'anlus ^I'igineta 
and of Hippocrates was sun-fever or lioat-apoplexy. — i'c Acre, Aquin, cf Loci>:. — (IV. 91, 
103, 101.) 

In August, 1871, a lady, while recovering after confinement, ' retired at 9 p.m. ; awoke at 
midnight with thirst, restlessness, and voiding much urine.' All the usual symptoms of heat- 
apoplexy rapidly progressed ; the temperature in the axilla reached llO-l' Fahr. — the limit of 
the thermometer — and death took place. — (VIII. 27.) 

In July, 1875, sun-mahii^c was common, and children ])assing through the period of dentition 
suffered severely from it. — (X. 55.) In the month of October, 187G, several cases of the same 
affection occurred, but were usually linked with some error in diet. — (Xltl. 41.) 

From the 8th to 18th August, 1870, the temperature never fell bolow SO' Fahr., the 15th 
being the hottest of the season, namely, at 2 p.m., 99° Fahr. From the 10th to the 15th there 
occurred ten cases of heat-apoplexy, one being fatal. — (XVIll. 81.) 

At Ningpo, during the early part of May, ]S77, when the morning sun was vei-y hot, several 

„. cases of hea,t-mahii.'<r came under notice. These, Dr. Mackenzie considered to be 

Ningpo. 

due in most instances to want of care in wearing proper head-covering. — 
(XIV. 65.) 

At Foochow, according to the Report for the half-year to September, IS71, it is observed that 

cases present all the symptoms of sunstroke, although the patients have not been exposed to the 

direct rays of the sun : hence the term heat-apoplexy is moro correct than snn- 

Foocliow. i. 1 rni i. 

stroke. 1 hat season was very cool, and consequently only one case occurred; it 
ended in recovery. — (II. 27.) 

In the Report to September, 1872, the statement occurs that the cases noted as ' snn-vuilaisc' 
might have been placed under ' febricula;' but they were kept apart on account of the similarity 
of many of them to an ordinary attack of ague. — (IV. 58.) According to that to September, 1871, 
heat-mnktse was among the chief complaints prevalent during the period; it was considered to 
f.>e ' undoubtedly climatic.'— (VIII. 62.) 

In the Report on Foochow, April to September, 1875^ Dr. Somorville considers the subject of 



HEAT-MALAISE AND HEAT- APOPLEXY. 123 

Heat-Malaise. He writes that it is a protean malady ; its most common symptom giddiness, its 
subjects sometimes staggering and wild-looking ; that these indications disappear under treat- 
ment, or on the approach of cold weather ; that cases of the affection so named occur more 
frequently on board ship than on shore^ and that ships' cooks are the class of all others most 
subject to it. He considers that it occurs from exposure to the sun, and has no connection with 
' what is called malaria.' — (X. 35, 37.) 

In the period from April to September, 1877, there were fewer cases of heat-vialaise than 
usually occur in the hot season, a circumstance accounted for by the comparative coolness of the 
summer months. There were, however, a few hot days in July, and on the 16th of that month, 
twenty men on board of a steamer were found ' quite knocked over by the heat.' Of these, the 
two worst cases were sent to hospital ; the others were treated by the application of ice, and 
administration of quinine internally — and of the latter, all recovered. — (XIV. 86.) 

At Swatow, during the summer of 1878, although cases of ' snn-malaise' were 
somewhat frequent, actual sunstroke did not occur. — (XVI. 26.) 

In the Report on Hoihow, for the period from April to September, 1881, the statement, 
occurs that there were three or four cases of heat-apoplexy on board H.M.S. 
Magpie during her stay at that place. — (XXII. 7.) 

In Japan, sunstroke is rare among the foreign community. Such cases 
as were recorded took place among the soldiers formerly stationed in Yokohama. 
—(XV. 59.) 



IX. PLAGUE. 

In the Eeport on Amoy for the half-year ending 31st March, 1878, there is an article on the 
Plague in China, prepared chiefly from notes by Mr. Rooher, of the Chinese Customs 
Service. These notes are believed to prove the existence of bubonic plague in China, that of late 
years the disease spread over a large area of the empire, and that it did not in reality disappear, 
as believed by some writers. 

In Tunnan the sickness known as Yang-hu, otherwise Plague, carries off yearly many victims 
in that province. It appears to have been imported from Burmah. Its early history is imper- 
fectly traced, but since the outbreak of the rebellion in that province it has spread 
among the population of it. A belief was expressed that its cause existed in ex- 
halations from the ground, because rats and other animals that live in it or much upon it, suffered 
in an especial manner. After animals had suffered, the disease spread to man. Then the people 
employ such ' sanitary ' measures as purifying their houses, lighting fires in every room, and ab- 
staining from pork. The reporter states that in Yunnan he has seen many persons attacked by 
the disease, but few recovered. In places where the plague passes but lightly through, the mor- 
tality may be estimated at 4 per cent. ; in places where it stops for some time, whole families 
disappear one after another, and the general population is decimated. In some districts the 
inhabitants, to avoid the pestilence, abandon their houses and harvests, and camp out on the 
hei'^'hts, where, however, in some instances the epidemic follows them. The dead are usually left 
exposed, unburied ; thus the Fung-shui is not desecrated by their interment ; but the odour from 
decomposing bodies is intense. 

In 1871, 1872, and 1873, the epidemic in Yunnan began about the period of rice-planting — that 

16—2 



124 EPITOME OF MEDICAL REPORTS. 

isj in May or June. Daring summer, which is also the rainy season, the disease continues^ 
but in a mild form; after the rains have ceased, however, it becomes most active and deadly. 
Instead of visiting every village in its direct progress, it would pass some completely by, visitmg 
places near to and on either side of them, to return several months afterwards to those forgotten 
spots, when elsewhere it would appear to have died away. After having devastated villages m 
the plains, it often ascended mountains, and there affects severely the aborigines. It was con- 
stant among the Imperial troops during the years named, while they were operating against the 
Mahometan rebels. *■ One is inclined to believe that the disease is imported by men and women 
who descend into the valleys to barter, or work at certain seasons at the harvest, as it is chiefly 
the mountains adjoining the plains that are visited by the disease.' — (XV. 25-27.) 

X. CHOLEEA. 

Cholera has been known in China, as in India, from time immemorial. Two thousand years 
before our era it was described by the very name it now beara, namely hwo-luan, an expression 
meaning something huddled up in a confused manner inside the body, and which 
istory. ^^ evidenced by the vomiting and purging. No mention is made in early history of 
the epidemic character of the disease. In the Neiching, a supposed work of the Emperor 
Hwang-ti, b.c. 2500, cholera is said to be due to the development of three pent-up airs, which 
give rise to vomiting and purging. These are developed by irregularity in the seasons, the pre- 
valence of wind, and the absence of rain, whereby what is eaten remains undigested ; the body 
consequently becomes heavy, the belly painful, and spasms attack the sinews. An author during 
the Tang dynasty, a.d. 620-907, attributes it to food, ' and not to demons.' A writer of the Yuen 
dynasty, A.D. 1280-1368, ascribes it to retained ingesta, aided by certain external influences such 
as cold, by which the male principle {yang) ceases to ascend, and the female (yin) to descend, and 
the diaphragm is drawn down. Another author, Li-Ting, of the Ming dynasty, a.d. 1368-1644, 
ascribes the disease principally to heat, for the reason that it prevails mostly in summer and 
autumn, and very rarely at other times. — (IV. 39.) 

Chinese writers divide cholera into two kinds, the wet and the dry. By the latter is meant 
the absence of vomiting and purging ; it is considered the most fatal form. — (IV. 40.) 

According to Cleyer, cholera prevailed as an epidemic in China in 1669, on which occasion it 
was ' probably ' brought from Malacca. Gentil alludes to the disease as prevailing ' in the 
CoromandeP (coast) in 1 761 and 1 709, and states that shortly after the latter date it was present in 
China. The epidemic of 1817 extended from Bengal to Dacca ; thence north-eastward along the 
Brahmapootra to Rungpore, whence it travelled to the borders of Thibet and South-western China. 
In 1820 it again appeared in the latter country ; first at Canton, whence, as from a focus, it 
penetrated into the interior of the empire by direct route ; it radiated to Ningpo, and thence 
upwards along the Yangtze Kiang. In 1821 it reached Peking, where, in 1822 and again in 
1823, it prevailed, forming the centre of infection in Northern Asia. In 1826 it was again borne 
from India to China. It reached Peking, whence advancing, it crossed the Chinese Wall, swept 
through Mongolia, and onwards to Moscow. In 1840, by means of the expedition from India, 
the disease once again reached China. It travelled to Peking, thence by caravan-route westward 
to Russia. In 1841 it prevailed in malignant form at Ningpo ; in 1812-43 it affected the men of 
the British East India squadron. Prom that date a lull in its record appears, lasting fifteen 
years. In 1858 it reappeared ; and year after year continued to do so till 1867. Then a,nother 
lull, till 1877.— (XVIII. 2.) 



CHOLERA. 125 

At Peking, during tBe two years ending September, 1872, cholera only once occurred as an 
epidemic, namely, in tlie summer of 1862. It then lasted two months ; and is believed to have 
carried off 1 per cent, of the population, estimating it at a million and a half. The Pekintr 
disease was first heard of at Taku, then at Tientsin, where it was very virulent, 
and exceedingly fatal. It followed the course of the Peiho river, attacking the various towns on 
its banks, and thus reached the capital. The disease appeared first in the southern city, but 
soon spread to the northern; yet, when it had entirely left the latter, many fatal cases still 
occurred in the former, where the offal and filth of the people were thrown into the city moat. — 
(IV. 39.) 

At Tientsin, in August and September, 1877, cholera of a very fatal type prevailed. The 
disease made its appearance at Taku, and gradually spread by the villages along the river-side 
until it reached Tientsin. For some days the epidemic made alarming strides ; but 
a sudden fall of temperature having occurred, its progress became checked. — 
(XIV. 66.) In the autumn of 1878 it was reported that a foreigner died of cholera in a Chinese 
gunboat, lying outside the bar of Taku. In September several cases of choleraic diarrhoea 
occurred in Tientsin, but no epidemic outbreak took place. As elsewhere detailed, a few months 
previous typhus fever was epidemic. — (XVII. 34). 

At Newchwang, on 15th August, 1876, a solitary case of cholera, and it fatal, occurred in the 
person of a Sister, occupying a building situated in a notoriously unhealthy 
locality. The mission subsequently removed from that position. This was the 
only case that occurred. It was considered that the attack was not due to contagion, but to 
insanitary local conditions. — (XII. 28.) 

On 26th July, 1876, a case of cholera occurred in the person of a man belonging to the 
Customs police. It proved fatal. During the previous part of the month, diarrhoea had been 
very prevalent among the Chinese inhabitants. Cholera afterwards prevailed extensively 
among the native inhabitants, and also affected persons on board the shipping. Foreign 
residents, however, escaped the disease. A similar occurrence happened in 1862, that year 
being the date of the previous outbreak ; but as then, so now, the exemption was assigned 
to the social and hygienic conditions of the latter rather than mere difference of race. 
Everyone was alive to the necessity of early treatment. In an estimated population of 50,000, 
the epidemic carried off 50 to 200 daily, and doubtless mortality would have been greater but for 
early treatment applied. During the epidemic, the excitement among the natives was astonishing ; 
whole tribes ceased business and fled, thus, it was presumed, carrying disease to many an outlying 
hamlet. It was observed that on 25th July — that is, the day prior to the outbreak of the 
epidemic — there occurred a cold wind from the north, with heavy rain. Immediately afterwards 
the mortality rapidly increased, and continued high until it began to decline, and ended by the 
middle of October. It was believed that the first cases of cholera had been brought in junks 
from Amoy. — (XV. 28, 29.) In the period to March, 1879, one case of cholera occurred. It was 
in the person of a Chinaman on board a steamer just arrived from Shanghai. He recovered 
—(XVII. 11.) 

In the Report on Kiukiang to September, 1872, four cases of cholera are detailed. They 
occurred in foreigners, of ages ranging from two to thirty-four years. Recovery 
took place in all, ' owing mainly to the use of calomel.' — (IV. 49.) 

At Hankow, during the year ended September, 1878, several cases of sporadic cholera 
occurred. The disease attacked the workmen in the Brick-tea manufactories, and the natives 



126 EPITOME OF MEDICAL KEPORTS. 

residing in the convent. Thus it was not dependent upon conditions limited to one class of per- 
sons. — (XVI. 23.) In the Eeport to March, 1881^ it is recorded that during the period in 
question^ together with the prevalence of dysentery and diarrhoea — the latter chiefly 
among children — there were two cases of sporadic cholera, one of them fatal. 
—(XXI. 45.) 

In regard to Ichang, Dr. McFarlane, in his Report to September, 1880, observes 
that since 1850. no epidemic of cholera had visited these parts. — 
'^"'"^- (XX. 20.) 

Cholera was considered to have been almost unknown in China previous to the year 1838. 
In that year a large body of native troops arrived from India, and simultaneously with their 
arrival a marked increase took place in the prevalence and in the mortality of 
cholera. Indian troops serving in China are said to have shown a far less liability 
to the disease than Europeans, and when attacked recover in larger proportion than the latter. 
Throughout the year 1802, 141 cases of cholera were under treatment in the British squadron in 
China, and of these 80 were fatal. Prior to that date, the disease was prevalent among the 
Chinese rebels j it spread to the towns they were investing, and extended in a northerly direction 
to the Peiho. It was very severe at Ningpo and Shanghai, attacking also the foreign residents 
living on shore at those places, as well as the naval and other shipping. It extended to Japan, 
and at Nagasaki and Hakodadi especially committed great ravages. 

On the occasion of the outbreak of the disease at Shanghai, in 1862, the first case occurred on 
board the Goromandel. Between that date and the 29th of the same month two other persons 
on board that vessel were attacked, the issue being fatal in one ; but from that date till October 
no further case occurred. In the Euryahis there occurred thirty-nine cases with twenty-one 
deaths, the outbreak being assigned to the fact that the men had been exposed to fatigue in 
Ka-ding immediately before attack. It appears that a portion of the troops from the Euryalus 
were marched from Ka-ding to Shanghai, and they not only remained compai'atively exempt, 
but improved in health ; it being chiefly those who remained on board who suffered. The extent 
to which the native inhabitants of Shanghai suffered on the same occasion seems to have been 
something terrible. The Imperieuse, anchored off Shanghai, had thirty-five cases on board, of 
which number fifteen proved fatal. Among the British troops in the north of China during the 
six months the epidemic prevailed in 18G2, one-twentieth of their whole number were carried off 
by it, while the loss among the native population was calculated at one-eighth of the whole. 
On the occasion of the outbreak at Shanghai, in 1863, the strength of the forces on shore at 
that place was 1,362 white, and 1,061 black troops; of the former, 141, equal to 10'35 per cent., 
were attacked, 79 of whom died, or equal to 5G73 per cent, of the cases ; of the latter, 40, or 
3'77 per cent, of strength, were attacked, and of these 15 died, equal to a ratio of 3750 per 
cent, of cases. 

In 1863 cholera reappeared at Shanghai in the month of June, and continued to prevail 
through that month, July and August. At that time the heat of the weather was remarkably 
great, and cases of coiqj de soldi were reported as being numerous. The type of the prevailing 
cholera, however, was described as more virulent than it had been in 1862, and of the oflicers 
and civilians, living under relatively favourable hygienic conditions, scarcely one became affected 
by the disease. The 67th Eegiment occupied a Confucian temple in the city, their surroundings 
of the most offensive description ; twenty men of that regiment died by the disease, this high 
rate being deemed due to the faultiness of their position. Throughout the epidemic, out of a 
strength of 718 white troops there were attacked 58, equal to 8-08 per cent.; there died 44, 



CHOLERA. 127 

equal to 30'10 per cent, of cases. Of a strength of 886 black troops, there were attacked 55, 
equal to 6"21 per cent ; there died 9, equal to 16'36 per cent, of cases. 

In 1864, a few cases of cholera occurred among the crews of ships lying off Shanghai, there 
having been in all ten deaths among them from this cause. Among the troops on shore, only 
seven deaths took place, so that the disease can hardly be said to have been epidemic. 

With reference to the occurrence of cholera at Shanghai during the preceding three years, 
the remark occurs that throughout the period the absence of ozone had been remarked j also 
that there was a remission of attacks after heavy rains, with thunder and lightning. 

In 1865, cholera appeared in the month of August among the foreigners and Chinese at 
Shanghai. A fatal case also occurred on board the Perseus. — (XIY. 40, 41.) 

At Shanghai, a severe and frequently fatal form of bowel affection, attended by vomiting and 
cramps, attracted attention in August and September, 1875. Dr. Jamieson directed attention to 
the instructions on the subject of that disease, issued by the London Local Government Board 
in 1874. He observes that when, in the same year, patients at Simla affected with cholera 
were treated in their own homes, there was no reason to believe that any spread of the disease 
was due to that circumstance. — (X. 55.) 

In October and November, 1875, a brief and limited epidemic of cholera occurred. In the 
treatment of the disease ' intravenous injections of a saline solution, with subcutaneous injec- 
tions of quinine, produced a good effect for a time, but the case proved fatal in twenty-eight 
hours from the first onset. •" A code of sanitary instructions was issued on 26th October. On 
12th November, the visitation suddenly ceased. Dr. Jamieson remarks that, ' Some cases of 
cholera will recover, no matter what treatment is adopted ; that the algid stage of pernicious 
remittents is undistingiushable from cholera ; that there is a belief that cholera is in reality a 
fever, if not identical with the worst malarial fevers.^ — (XI. 49.) 

The disease again prevailed in that city and settlement in September, 1877. It was noted 
at the time that the amount of ozone in the atmosphere was remarkably small. The disease 
threatened in June of that year, but the suspicion of its regular outbreak till September is 
theoretically assigned to the violent storm which prevailed in July, and in the first three weeks of 
August. On 2nd July, a telegram intimated the occurrence of the disease at Amoy. Not 
until August, however, did it appear in Shanghai, and during that month there were only two 
deaths by it. In September, there were twelve cases ; of these, four were mild and they recovered ; 
eight severe, and of them, six died. During October there were four admissions by the disease, 
the last that happened in this outbreak being on the 5th of November. — (XIV. 38.) Thus, 
among foreigners, there were in all twelve admissions and ten deaths by pronounced cholera, a rate 
of mortality accounted for partly by the mal-hygienic circumstances under which its subjects 
lived, and partly by their having been intoxicated and exposed at night prior to attack. — 
(XV. 3.) The circumstance is particularly noted, that during the prevalence of cholera, there 
was also an unusual amount of diarrhoea, often attended by vomiting and cramps. — 
(XIV. 40.) 

In further reference to the outbreak above recorded. Dr. Jamieson wrote : ' It appears certain 
that we must count upon the annual occurrence of cholera of some sort until such time as we 
discover its source, and arrest it there. It should not be forgotten that, in forms of greater 
or less severity, cholera every year attacks the natives around us, about whom we know so 
little.' Dr. Galle seems to attribute the periodic visitation to the want of a public slaughter- 
house, and to the absence of suitable carriage of night-soil. Dr. Little refers the prevalence 
of the disease among the shipping to the consumption of water contaminated by excretions of 



128 EPITOME OF MEDICAL REPORTS. 

Chinese affected by it ; tence an order was issued that ' boiled water, or boiled rice-water, should 
be provided for crews, and none other to be drunk,^ a measure as to the effectual carrying out of 
which doubts exist. It was observed that, almost without exception, men seized with cholera 
were on a debauch, or had been on a debauch just previously. Instances occasionally arise m 
which apprehension plays a large part, if not the principal part, in producing cholera. At 
least two such instances arose during last year. Mental conditions will produce ague, or an affec- 
tion undistinguishable from ague, and curable by quinine, and cholera presents many analogies 
with malarial fevers. So faint is the line which separates the ' avoidable ' and the unavoidable 
disease, that were a few isolated cases of cholera morbus to occur, and after an interval to be 
succeeded by cases of precisely the same character, but occurring in large numbers, the latter 
group would be described as malignant, or Asiatic, or epidemic cholera. ' Epidemic ' and ' malignant ' 
are convertible terms as applied to cholera. With reference to secondary fever in cases of 
cholera, the remark occurs that fever of a typhoid character may be developed, the term 'typhoid' 
doubtless being applied as expressive of a condition merely, not of a specific form of disease. 
Alluding to anuria, the reporter lays stress upon the fact that it was absent in some of the cases 
which occurred ; also that the same symptom is occasionally present in so-called pernicious 
intermittents. As to the histories of individual cases during life, they may in almost every instance 
be explained without having recourse to the specific poison of cholera, whatever that may be, as 
the disease material, The overwhelming majority of cases were furnished by sailors, a class of 
persons reckless, prone to excess, unsuitably clothed, badly fed, drinking impure water and 
adulterated liquor.— (XVII. 21, 22, 25, 26.) 

In August, 1879, two fatal cases of cholera occurred among residents of Shanghai. There 
was, however, nothing even remotely resembling an epidemic. A case is recorded, occurring in 
a middle-aged adult ; no urine was passed, and none apparently secreted during the period of 
purging ; but as soon as this was checked (by morphia hypodermically, ice internally, and heat to 
the surface), the secretion was re-established. Bight cases of a similar nature (one fatal within 
half an hour) were brought to the Gutzlaff Hospital ; all recovered except one, moribund when 
admitted. In all but one there was a history of sleeping in the open aii' on the previous night, 
and of indulgence in raw fruits and ices. — (XVIII. 82.) 

During the entire hot season of 1879, three deaths were reported as from cholera, two in 
August, and one in October. What the nature of these cases was the reporter had no means of 
ascertaining, but ' assuredly there was no such thing as an epidemic of cholera last year.' — 
(XIX. 19.) 

In the Eeport to September, 1880, two deaths by cholera are recorded; but there was no 
epidemic of choleraic affections, although at the approach and during the continuance of hot 
weather, a large mortality among native residents was announced. The cause of this yearly re- 
curring mortality is only vaguely described. — (XX. 34.) 

During the six months from October, 1881, to March, 1882, five fatal cases of cholera occurred 
— all among sailors. With reference to them Dr. Jamieson writes : ' Year by year the same rule 
is observed, that it is only those who expose themselves without precaution to sudden changes of 
temperature, or to miasma arising from the ground within and around houses in the worst parts of 
the native quarters, or who have committed imprudences in eating and drinking, or are the sub- 
jects of chronic alcoholism, that present the group of often fatal symptoms, which it would be 
inconvenient to call cholera were it not that most people associate with this term the idea of 
epidemicity, and therefore of inevitableness. — (XXIII. 43.) 

At Ningpo, during October and November, 1877, an epidemic of cholera prevailed among the 



CHOLERA. 129 

native Ctinese ; among foreigners only one case occurred. That epidemic wa.g contemporaneous 

with, the prevalence of cattle disease, but what connectionj if any, existed between 

them ' remained to be seen.' — (XVII. 6.) ^^SP"- 

At Wenchowj during the summer of 1877, cholera prevailed about ten to fourteen days, as it 
did in most places in China. Little or no treatment appeared to be adopted by the natives — 
opium-smokers almost certainly died. As soon as a native doctor made out the 
nature of the case he departed, and the domestic offices for the dead were begun. 
The epidemic was not spread over the whole city, but chiefly confined to one quarter ; this was 
attributed to the general 'sanitary' condition of the city. The symptoms were peculiarly un- 
demonstrative, the patient frequently appearing to rally, and in many cases the fatal termination 
was not preceded by any appreciable collapse. Purging and vomiting, except on a limited scale, 
were rare; but the mortality among the attacked was very great. — (XV. 41.) 

In 1878, there was a visitatioa of cholera in August. The epidemic did not last long, nor did 
the Chinese public suffer to the same extent as in the previous year, notwithstanding the absence, 
as then, of all treatment. It also affected foreign residents, and appeared on board the shipping. 
Among remedial measures recorded, was the method of placing the patient in hot dry air. Thus, 
on board the Fci-Hoo, the patient was placed between the boilers of the ship, kept in a tempera- 
ture of 120° Fahr., and allowed to drink freely of iced water. The following morning he waa 
convalescing. — (XVIII. 60.) 

In the Eeport on W^nchow, April to September, 1881, Dr. Macgowan enters upon the 
history of cholera in China. Wenchow has had its full share of ravages by that disease, 
regarding the origin of which authorities differ. According to one set of writers it originated 
in the Gangetio delta in 1813 ; according to another, accounts of its prevalence occur in the 
writings of ancient Sanscrit, Greek and Arabian authors, showing that after periods of 
quiescence it recurs at intervals, sometimes of a century or more. Some hold that all its 
phenomena are explained by contagion, or by a ' germ ' from excreta of cholera patients, or that 
water is the channel through which cholera poison is communicated. Others assign it to local 
influences ; and assert that it is not communicable from person to person, but is air-borne. Inl819, 
Indian or Asiatic cholera reached the Straits, by way, it is believed, of Siam. In May or June, 
1820, it appeared at Wenchow, and about the same time at Ningpo. Attacks of the disease, 
then popularly called 'the crab-claw disease,' were so sudden and fatal that people were stricken 
down and died in the streets. In 1821, it appeared in Kiahsing on the borders of Chehkiang 
and Kiangsu, and with such severity that one patient out of a hundred was not saved. The 
disease again prevailed in the two following years with unabated violence ; and since that period 
has been of frequent occurrence throughout the empire, notably in Chehkiang in 1860. At 
Wenchow, what is called dry cholera is common during the hot weather. At Canton, it is more 
frequent than elsewhere. It sometimes occurs in winter, however, and is now considered to be 
endemic in China. During the winter of 1880-81, various villages on the Pootung side of 
Shanghai suffered from Indian cholera j the epidemic less fatal than such as occur in summer. 
The cause assigned by the Chinese on that occasion was drought, and pollution of the canal 
waters. Dr. Macgowan considers that Indian cholera is a new disease in China; that it is duo 
to air-borne germs, influenced by atmospheric and telluric conditions, and that consequently 
the quarantine regulations to ward off invasion by it are futile. During the autumn of 1848, 
cholera was somewhat prevalent at Ningpo ; on the same occasion Rubeola existed epide- 
mically at that place. The latter disease prevailed in the maritime districts of the east coast of 
China, including the Samoyedes, among whom it was particularly fatal. In China it affected 

17 



130 EPITOME OF MEDICAL REPOKTS. 

both natives and foreigners. Whilst rubeola was traversing this region o! the earth from the 
Tropic of Cancer to the Frigid Zone, cholera was pursuing a western course from the Yolga 
to the Mississippi. Besides the epidemic above named as occurring in winter and spring at 
Shanghai, epidemics of measles and small-pox appeared concurrently, the former in the depart- 
ment of Soochow, the latter at Nanchang, in the province of Kiangsi. In Soochow, the type of 
measles was particularly severe ; the reason assigned being the drought of winter followed by 
a rainy and snowy spring. ' The synchronous prevalence of cholera, small-pox, and measles, is a 
noteworthy epidemicological phenonemon.^ — (XXII. 2(3.) 

At Foochow, during the half-year from April to September, 1877, 'the great nosological 
feature of the season was an epidemic of cholera among the Ohinese.-" Every year, during the 
summer, there are a few sporadic cases of the disease in the city; but this year it 
appeared as an epidemic, and was very fatal. It does not appear that it has so 
prevailed in this place for the past ten years ; for the present occasion the rate of mortality 
among the attacked was about 75 percent. Only two Europeans were attacked; both died. 
The drinking-water was boiled ; salads and fruit interdicted, except the latter in a cooked state. 
The disease began in the last week of August ; the last cases occurred on the 18th of August. 
Quoting from Drs. Lewis and Cunningham, Dr. Somerville wrote : ' Until it be proved that 
living substances can withstand immersion in a fluid at a temperature of 212° Fahr. of some 
minutes' duration, we have no hesitation in stating that the morbid phenomena which we have 
observed to follow the introduction into the animal economy of strained solution of choleraic 
and normal alvine discharges and of other decomposing animal substances, are not the result of 
ingestion with a material the poisonous properties of which are dependent on its possessing 
vitality.'— (XIV. 85, 86.) 

In 1879 cholera was said to be endemic there; 'sporadic cases occur every summer. It 
seldom attacks the foreign community ; but when it does so, individual cases are usually very 
severe. At different periods, but upon the whole about every ten to eleven years, cholera 
becomes epidemic. The last epidemic was in 180 7, the one before that in 1861. Both proved 
very fatal among the Chinese, but each epidemic carried off only one foreigner — the persons pre- 
viously ailing and of debilitated constitution.' The epidemic of 1807 was more virulent than that 
of 180 i; that is, if it did not kill more, it killed in less time. ' There was no diarrhoea, no vomit- 
ing ; no time seemed to be given for either in the height of the epidemic or in its worst seizures. 
People were struck down as with a blow.' The epidemic took a circular course, almost in the 
shape of the letter S. It did not run along the crowded thoroughfares simply ; sometimes it did 
so, sometimes diagonally to them, according as they harmonized or not with its path. The 
course was a narrow one, and quite definite, reminding the reporter of tornadoes in certain parts 
of the United States. As in those tornadoes the destruction was not only of small breadth but worst 
towards their middle, and bounded by an abrupt edge, so in this outbreak of cholera — in the centre 
of the epidemic-path the mortality was prodigious, but lessened and lessened outwards therefrom 
till the line of non-involvement was abruptly touched. Thus a track of death and woe ran throuo-h 
the city, and eighty yards from its centre, maybe, there was no death-stroke.' From what he has 
seen of two epidemics in Foochow, Dr. Stewart is ' disposed to accept with suspended assent' 
some of the recent theories about the transmission of cholera. — (XVIII. 67, 68.) From the 
above date up to March, 1881, cholera had not recurred in Foochow. — (XXI. 52.) 

Prior to 1821 there is no record of Asiatic cholera having occurred in Fukien; in that year, 
however, it prevailed during the months of August and September. A similar epidemic was 
described as prevailing in Putien-hien, a district surrounding the city of Hinghwa-fu, near Amoy, 



CHOLERA. 131 

during July and August, 1822 ; the disease reappearing there in the following year. On those 
occasions the name given by the natives to the affection was 'the men-in-the- 
morning-and-spirits-at-night disease.-" — (XIY. 33.) The sources of information 
regarding early epidemics of cholera in China are very limited. In the summer of 1858 an 
epidemic of Asiatic cholera prevailed at Amoy and its neighbourhood, carrying off many natives 
and foreigners, on shore and afloat. In 1864 an epidemic of similar severity occurred, very many 
of the Chinese community and several foreigners dying of it. At the same time diarrhoea, 
acute and chronic, and fevers were prevalent among foreigners living at Amoy, although nowa- 
days (1877) such diseases are almost unknown. — (XIY. 32.) 

During the months of August and September, 1875, a good deal of choleraic diarrhoea pre- 
vailed among the Chinese. In September and October the disease increased in severity. "With 
the occurrence of cold weather in November it decreased, and in December entirely ceased. In 
frequent instances death took place within twelve hours from attack. The attack was sudden ; 
vomiting and purging, copious watery evacuations, cramp and coldness of the extremities. 
—(XL 30.) 

During the half-year ending 30th September, 1877, an epidemic of cholera occurred. The 
epidemic first appeared on 30th June, in the person of a Manila man who died on that day with 
all the symptoms of the disease. Inquiry then elicited the fact that since the first week of that 
month many deaths had occurred from a similar affection, these deaths being said to be confined 
to a low-lying and filthy part of the town known as Tek-tchui-kha. During the last few days of 
June, and all July, the disease prevailed extensively among the native population. In the first of 
the latter month a case occurred on Kulangsu, in the person of a man who had recently arrived 
from the country, and from that time the disease spread rapidly in that portion of the settlement. 
The circumstance was also noticed that for some time before the outbreak diarrhoea had been very 
prevalent among Europeans, both ashore and afloat. The first case among foreigners occurred 
on 2nd July, on board H.M.S. Hornet, and throughout that month a considerable number of 
foreigners were attacked, the deaths among them being somewhat high. Among the Chinese the 
disease was reported to have spread to the large cities in the neighbourhood of Amoy, and that 
the mortality was very great. In the city of Chinchew, sixty miles to the north of Amoy, on the 
high-road to Foochow, the mortality by cholera was particularly great ; and the remark occurs 
that on this occasion, as on others, the disease was imported either from Saigon, or from Sin- 
gapore. By the end of August the disease had practically ceased in Amoy. In reference to that 
outbreak of the disease. Dr. Manson wrote : ' Why did cholera first appear iu one corner of the 
comparatively small town of Amoy, and thence spread over the whole town, and then to the large 
cities in its immediate neighbourhood, and afterwards make its appearance successively at dif- 
ferent ports on the coast, reaching at present as far as Japan ? The answer is easy enough. 
Amoy town itself is the port for the great cities in its neighbourhood, and the centre of a 
great Chinese passenger traffic.^ He then proceeds to discuss the subject of Quaeantine. — 
(XIV. 27, 31.) 

During the six months ending September, 1879, there were, as usual, several cases of diarrhoea 
among children, but there never was a suspicion of cholera. — (XVIII. 59.) According to the Report 
onTamsuiand Kelungfor the half-year ended September, 1877, cholera, severe this 
summer at some of the Chinese ports, did not attack the inhabitants of Northern ^''^^^^"'^ 
Formosa. There the towns are situated widely apart, and are neither large nor 
excessively overcrowded, while the people are, for the most part, in comparatively comfortable 

17^2 



132 EPITOME OF MEDICAL REPORTS. 

cii'cumstances. Abject poverty, so frequently noticed in many of the large cities on tlie mainland, 
is scarcely ever to be observed. — (XIY. 82.) 

At Takow and Taiwan-fu^ in the half-year ending March, 1876, it does not appear that cholera 

occurred. In the district inland from those places, however, an epidemic of ' simple cholera ' 

occurred; cutting oif many of the weak and sickly, and causing considerable con- 

Takowaud sternation among the natives.— (XL 26.) In that ending March, 1878, cholera, 

which visited several ports on the mainland, never appeared in the south of Formosa, 

notwithstanding that during the prevalence of the disease at Amoy and Ohinchew, an extensive 

trade by means of junks and foreign vessels took place between those places and the various 

small ports along the west coast of the island. — (XV. 37.) 

At Swatow, during the six months to September, 1871, together with a somewhat extensive 
prevalence of ague and diarrhoea, some few cases of cholera occurred among the native Chinese. 
It does not appear that the disease was here epidemic, but, in the neighbouring dis- 
trict, choleraic diarrhoea was very prevalent. — (II. 9.) In the last five months of the 
period ended September, 187-1, cholera was again very severe and fatal among the native Chinese in 
the same district. Europeans, however, did not feel it much; only four cases having occurred 
among them — all on board ship. The first case known of was in May, and the disease was at its 
worst in September. The epidemic was travelling from south to north. Cholera as an epidemic 
had not been known here since 1865 until 1874. — (YIII. 66.) 

In the summer of 1875 the native population again suifered from a very severe epidemic of 
cholera. In the cases of a few European sailors in harbour. Dr. Scott ' tried the hypodermic 
injection of chloral hydrate, but without any good results.'' He, however, found that drug, ad- 
ministered by the mouth, very useful in the spasmodic stage of the disease. All the foreigners 
on shore escaped, with one exception, and he lived ia the Chinese town. — (XI. 29.) 

According to the Report for September, 1877, ' diarrhoea was not more prevalent this year 
than usual, though there were some cases accompanied by vomiting and abdominal cramps. The 
cholera wave, which this year swept over so many parts of China, passed by us. Cholera was 
not more prevalent than usual among the Chinese in this district, where it is endemic' — (XIV. 69.) 
In the period to March, 1878, a case of cholera occurred in a child eight years old, and ended 
fatally. This was the only case of the disease that happened among foreigners during the half- 
year, although among the Chinese in the neighbourhood there was much choleraic diarrhoea, as 
also fatal cholera, — (XV. 23.) In the Eeport to September, 1880, the remark occurs that the 
word ' cholera ' was not once heard, although usually during the hot months the disease is epidemic 
at this place.— (XX. 24.) 

At Canton, in the half-year ended September, 1871, diarrhoea and ' summer cholera ' prevailed 
among the Chinese. Epidemic cholera, however, had not visited the city since 1858. — (II. 70.) 
In the six months to September, 1873, the medical officer failed to meet with any 
case of actual cholera, although the disease was reported to exist. In July, the 
advance of the epidemic from Bankok and the Straits was looked for, especially as the heat of 
the season was then intense. The reporter observes that an occasional case of sporadic cholera 
does occur in the city, and that ' English cholera ' is very common every summer, although on the 
present occasion there has been very little of it. The term hoh-livan commonly used to signify 
cholera, the reporter thinks, answers more to the English than to the Asiatic form of the disease. 
It is a general term including colic, English, and sometimes Asiatic cholera. When the disease 
fakes on an epidemic form it goes by the name of wnn-yih, and not hoh-lwan, though wan-yih 
properly means pestilence. — (YI. 48.) 



CHOLERA. 133 

At Hoihow, ia the middle of July, 1881, a steamer landed 270 passengers from Bankok, 
■where cholera prevailed at the time of her departure therefrom ; and it was stated that, during 
the passage to Hoihow, two deaths by that disease had occurred on board. Dr. 
Aldridge believes that cholera made its appearance previous to the 8th of August, 
although it was on that date that he personally saw a case of the disease. It occurred in a 
woman who, up to one p.m., was in good health ; she was attacked at that hour, and died at 
six p.m. The disease then spread; deaths in four, five, and six hours being recorded. Most of 
those who died obtained their drinking-water from wells situated either in their yards or within 
a short distance of the street drains ; but almost the entire town population used water from the 
same sources. Diarrhoea was not a symptom that, as a guide to favourable or unfavourable prog- 
nosis, could be always relied on ; though evacuations were in fatal cases mostly numerous, 
death in some instances took place after two or three. During the epidemic, diarrhoea and 
vomiting were also prevalent; the diarrhoea more or less choleraic in character. As a remedy in 
such cases, a combination of sulphuric acid and opium gave the best results. Cholera spread 
from Hoihow to Kiungchow, but there its course was very mild. In the former place it gradually 
decreased, and by the end of September had ceased to prevail. — (XXII. 6.) 

A few remarks on the treatment pursued in cases of cholera by Chinese and European medical 
men respectively are added thus : ' The Chinese treat cholera somewhat after this manner. If 
there is premonitory diarrhoea, it is checked by opium, astringents, and carmina- 
tives. When the disease has manifested itself, they give stimulants to forestall the of Treatment 
collapse. They employ shampooing by ' skilled pinshers.' At Shanghai, 1862-64, 
the Chinese were said to cure many cases of the disease by means of acupuncture. At Foochow 
during the epidemic, in the summer and autumn of 1877, a number of prescriptions for the 
disease were posted about the city. The most of them recommended external irritation, and 
' hot medicines, i.e. ginger, pepper, etc' For the most part the natives, during an epidemic, 
take refuge in gong-beating, paper-burning, and sing-songs j in some instances, at least, patients 
suffering from cholera are placed on the roadside, and there left to die. — (XIV. 31, 41, 85.) 

At Amoy the treatment employed by English physicians for cholera consisted of astringents 
and carminatives, stimulants, medicines administered hypodermically, fric- 

-, , . -r. , T, T ,. . T ; , /i ,. . c English Method. 

tions, and shampoomg. By the liberality or one individual, large quantities oi 
astringent pills were distributed among the Chinese; and being taken during the stage of pre- 
monitory diarrhcea, are believed to have been the means of saving many lives. 

At Shanghai, during the prevalence of cholera, ] 862-64, a great variety of treatment was 
adopted ; but large doses of chlorodyne with champagne and brandy were principally trusted in. 
From particulars gathered from reports of cholera in America, in 1873, the following ratios 
are given of mortality and methods of treatment employed, viz. : 
By Calomel in large and small doses . 

„ Calomel and opium 

,, Calomel, opium, and acetate of lead 

„ Calomel, opium, and stimulants 

„ Stimulants alone .... 

,, Preparations of iron 

,, Sulphuric acid .... 
When in August to September, 1877, cholera prevailed very severely at Tientsin the sub- 
cutaneous injection of sulphuric ether was adopted in one case. Recovery took place; but 
' convalescence was very slow, owing to an attack of secondary fever followed by purpura and a 



. 23 


per cent. 


. 31 


jj 


. 40 


}) 


. 50 


3> 


. 59 


i) 


. 33 


J} 


8 


31 



134 EPITOME OP MEDICAL KEPORTS. 

large abscess in the cervical region.' At Hoihow, April to September, 1877, the treatment con- 
sisted of frictions J packing in cloths soaked in mustard and water; hypodermic injection of 
morphia; administration of champagne. — (XIV. 31, 43, 44, 66, 85.) 

At Hoihow, in 1874, the treatment adopted in cases occurring among Europeans consisted of 
small doses of calomel every half-hour, and as much soda-water as the patient could drink ; but 
the medical officer cannot say much in favour of it. The first case known was in May, and the 
disease was at its worst in September. The epidemic was travelling from south to north. Cholera 
had not been epidemic at Swatow since 1865. — (VIII. 66.) 

Malignant or Asiatic cholera has appeared at Yokohama on one occasion only, during the 
ten years ending 1877. The epidemic of that year began at a comparatively late and cool 
season, and was not very severe, either as regards natives or foreigners. The 
''^™' epidemic of that disease, which occurred in 1861-62, was far more severe among 

the natives than that of 1877, but on the first-named occasion very few foreigners suffered 
from it. From the strangely irregular behaviour of this disease in different epidemics, nothing 
can be predicted as to the probable course of cholera in the future ; in the past, cholera has often 
leaped all barriers of social position or even of inferior hygienic surroundings. — (VI. 55.) 

In Japan, as in China, the early history of cholera is quite obscure. One Japanese authority 
gives 1817, 1854, and 1801-62 as years when epidemics occurred, while another fixes the dates 
1819, 1821-22, and 1858-59 as pestilential years. Although the great epidemic of 1817 had its 
origin in India in that year, it did not reach Java until 1819, China till 1820, and Japan in 
1321-22. With regard to the history of the disease in Japan, Dr. Simmons gives particulars as 
follows from a native treatise on cholera : In the summer of 2370 era of Jimmu, i.e., a.d. 1718, a 
fatal illness, under the name of 'fever,' prevailed in the city of Great Yedo; the mortality by it exceed- 
ing 80,000 per month; the dead so numerous that, interment being impossible, the bodies were buried 
in the bay adjoining. The prevailing disease was quite different from ordinary fever, and is con- 
sidered to have been the first occurrence of cholera in Japan. In 1850, an epidemic raged in Tedo 
and at several other places in Japan. During the first half of the eighth month of that year, the 
epidemic was at its maximum. ' At the gates of every temple there were hills of coffins ; men 
who worked at the cremation furnaces in the evening were themselves changed into smoke the 
next morning.' The disease was attributed to diabolical agency, hence the people gave it the 
name of ' fox, wolf, and badger.' It was believed that all water and all fish were poisoned, so 
that people dared not draw water from the pure stream of the upper Tamagawa, nor eat any 
fresh fish, even when it was brought alive to their doors. Everyone adorned his gate with 
branches of pines and bamboo, and straw ropes ; at the same time some of them offered prayers to 
the hami, others to Buddha. On that occasion, certain instructions were issued by the Bakufu, 
having reference to the prevention of cholera, and to the treatment of patients suffering from that 
disease. They were nearly as follows : '^ In the way of precaution, avoid exposing your body to 
cold air ; wear a cotton belt round your abdomen ; be careful to avoid gluttony and excessive 
drinking, and the eating of indigestible food.' In the way of treatment : ' If symptoms appear, 
go to bed ; be extremely careful of what you eat and drink ; keep the whole body warm, and 
take the medicine /tofeo-ivui,' prepared by mixing together yekichi and dried ginger in equal 
quantities, and boil ; drink at intervals one or two cupfuls at a time. ' If you vomit and purge 
much, and your body becomes cold, put 2 monme of refined camphor into 2 r/o of spirit 
{sho-chiu), warm the mixture over the fire, dip a cotton cloth in it, and rub the body and limbs 
briskly.' The application over the stomach of a mustard plaster composed of powdered mustard- 
seeds, wheaten flour and vinegar is also recommended ; or, in urgent cases, mustard only mixed 



CHOLERA. 135 

with, hot water. Another form of medicine is this : Into a certain measure of tea pour about 
one-third the quantity of spirit ; add a little sugar, and drink. The patient to be placed in a hot 
roomj and his body rubbed with a cotton cloth soaked in spirit ; if the extremities are cold, hot stones 
to be applied. [These instructions, bearing the Japanese date 8th month of the year of the Horse, 
5th of Anseij 2518 of Jimmu, do not materially differ in kind from such as might, if need were, be 
issued in the 9fch month, 47th year of Victoria, a.d. 1883.] In 1851, cholera is said to have been 
imported by the U.S. frigate MississijijiL Most of the great cities suffered most intensely; and subse- 
quently for several years endemo-epidemics showed themselves in Yokohama at one particular 
season of each year. It is observed, however, that no mention of the disease on the occasion 
named was made by the medical officers of either the American or British fleet. In ] 861, the occur- 
rence of cholera was preceded by an epidemic of measles, originating from the family of a British 
ofiicial, by means of whom it was introduced. Many persons were attacked with cholera while 
still unrecovered from measles, and hence, as was believed, much of the high rate of mortality on 
this occasion. At that time the propriety of establishing a system of maritime quarantine was 
considered, but the epidemic had ' exhausted itself ' before the necessary arrangements could be 
made. As cholera occurred in China, as already noticed, in 1858, and continued to prevail in 
many parts of that country from that date onwards till 18G1 and 18G2, a connection between the 
outbreak there and in Japan may reasonably be assumed to have existed, if not actually 
demonstrable. From 1862 till 1877 — that is, during a period of fifteen years — cholera is un- 
recorded in Japan ; and not only so, but the circumstance is noted that, more especially in the 
northern portion of that empire, there was a remarkable freedom from intestinal disorders 
generally. Meanwhile, cholera continued to prevail in China during five years after it had ceased 
in Japan, namely, till 1867, communication by sea between these countries being constant as before. 
On the 7th of July, 1877, the Japanese consul in Amoy telegraphed to his Government the 
existence of cholera in that port from about the 27th of June. In reply to a telegram from the 
British minister at Tokio, the Hong Kong authorities stated that they did not consider the 
disease in Amoy sufficiently severe to justify the declaration of quarantine. Yet the Japanese 
authorities, bearing in mind the great severity of previous epidemics, took precautions to stay its 
progress in the event of the disease entering that country. They erected temporary hospitals at sea- 
ports, and by means of newspapers and pamphlets gave information with regard to prophylactics 
and treatment. But the precise manner and means by which cholera reached Japan remained 
undiscovered. The existence of the Satsuma rebellion, then at its height, rendered it impossible 
to carry out efiiciently quarantine regulations, or inspection of ships. And so, sometime in 
August, the disease appeared in a small village half a mile from Nagasaki, the persons first 
affected having been washermen who attended upon shipping. The next day it appeared in an- 
other village at a little distance from the preceding, also among washermen similarly occupied ; 
on the same date on board an English war-ship in the harbour ; three days subsequently on board 
a U.S. naval vessel ; and meantime several cases were reported on board the merchant shipping. 
But no actual history of how the disease was brought to the locality. On September 4th, the 
ship BTiinagawa-Maru sailed from Nagasaki for Kagoshima, with several hundred police. A few 
hours after leaving port an engineer died on board from cholera ; within four days 90 of the force 
succumbed, and subsequently 110 more. — (XVIII. 3.) 

On the 5th of September cholera appeared in the village of Kanagawa which is a suburb of 
Yokohama. The first person attacked was the wife of a builder's coolie ; she died within twenty- 
four hours. On the 7th, her husband, grandfather, and son were attacked in the same house, all 
these cases proving fatal also. On the 9th, the fifth case occurred. It was in the person of the 



136 EPITOME OF MEDICAL REPORTS. 

Assistant-Judge of Yokohama, whose house was situated at Ise Yama, two or three miles dis- 
tant from the tenement in which the first case appeared, and on the opposite side of the bay. No 
communication appears to have taken phice between these two centres of disease. This lady also 
died. Case 6 was in the sister of the last named, to whom she had acted as nurse. Case 7 was 
that of a coolie-master; and so on to Case 11, the subjects of attack living at considerable 
distances from and having no communication with each other. 

From the 15th of September cases increased rapidly; the first persons attacked in the various 
localities were women, a circumstance said to be solved by the fact that near the place where the first 
case occurred was a temple much frequented by female devotees, connected with it some 'holy water' 
in a stone basin, into which, as part of their devotional ceremonies, they dip their fingers, or even 
wash their mouths or swallow portions of the consecrated element. ' The mystery would be solved 
by supposing the water of the basin to have been contaminated with cholera " germs." The well 
which furnished the water for the basin may have been the same as that used by the man who 
died of the disease in the neighbourhood.'' Of the first eleven cases all save one were fatal. 

Under the orders of the Local Health Board the most vigorous measures were at once taken 
with a view to check the spread of the disease. A special police force was detailed, and physicians 
and medicines placed in attendance at the several police-stations, a report having to be made at 
them of every case of cholera as it occurred. Carbolic and sulphurous acids were the disinfec- 
tants used. In a large majority of cases the bedding and clothing of the affected were destroyed. 
All corpses were cremated. Water-closets and drains thoroughly disinfected. The use of boiled 
water for drinking inculcated. 

Of resident foreigners, other than Chinese, twelve were attacked — of these four died, eight 
recovered. From the shipping there were six cases, all proving fatal, with one solitary exception. 
Only one authenticated case from China Town. There the water of wells was so bad that it was 
not used by the people, all of whom obtained their supply from a running hydrant fed by pipes 
from a neighbouring hill, and to this circumstance is attributed the lightness of the outbreak in 
that locality. 

As the scourge spread in Yokohama, diarrhcea, manifesting the presence of ' epidemic consti- 
tution,' occurred, but to a less degree than usual in similar epidemics. Dysenteric symptoms 
appeared at the end of the first month, and fijpltiiul symptoms towards the last. In Tokio it first 
appeared in the neighbourhood of the landing of the crews of fishing-boats from Yokohama ; it 
was most severe in the vicinity of the fish-market, and fish-vendors carried it to different parts of 
the town ; the number of cases, however, was very small when compared with those in Yokohama- 

When showers were falling slowly, no marked change was noticeable in the disease ratio; when 
rain was heavy for a few successive hours a rapid rise in that ratio always followed on the fourth or 
fifth day afterwards — a circamstance accounted for by the excess of water bringing about contamina- 
tion of the wells. Throughout this epidemic in Japan the recorded cases of cholera were 12,378, 
of which number 6,508, equal to 52'58 per cent., died. The attacks to population were 3'79 
per 10,000. 

In 1878 a number of cases of cholera occurred in Isaka, during the spring season. In Yoko- 
hama only two cases occurred during the summer. On 11th November, a case occurred in that 
portion of the town where the epidemic of the previous year had prevailed ; this was followed by 
a severe outbreak. With few exceptions the scourge remained in the district in which it had 
revived. The last instance occurred on 23rd January, 1879 ; the total cases from its recurrence 
33, deaths 25. During the year the general statistics of the epidemic in Japan gave 975 cases, 
deaths 532, equal to 5i'56 per cent. The cases to population not stated, 



CHOLERA. 137 

Ctolera lingered in Osaka and other aoutliern portions of Japan, and ial879 these places severally 
became foci whence the epidemic spread. Some time previous to 20th of April it appeared 
almost simultaneously in Tehime in Shikokuj Oita and Kagoshima in Kiushiu, and Hiroshima on 
the main island of Nippon. It manifested itself in Osaka and Hiogo two or three weeks later j 
then followed irregular courses, generally tending northward, until by the beginning of 
October it had overspread nearly the whole Japanese Empire. 

On the 18th of June, two steamers, the Niigata Maru and the Hiroshima Maru, both from the 
infected port of Hiogo, arrived at Osaka. A stoker of the Niigata Maru was, on the evening of 
his arrival, seized with cholera in a brothel, whence he was conveyed to the house of a friend iu 
Kanagawa. The quarter of the latter, where he stayed, became one of the foci of the disease. 
A man then living in Yokohama, where as yet no instance of the disease had declared itself, and 
who passed the remainder of the night of the 18th June with the same prostitute, was seized with 
cholera; but the woman escaped attack, as did also all the other inmates of the house. The next 
case was a passenger in the Hiroshima Maru, arriving from Kobe the same day. The third, that 
of a man occupying a dwelling close to the closet used by the last-named. This locality, one of 
the most favoured in the town as regards drainage and general hygienic condition of the people, 
formed another radiating point for this disease in Yokohama. 

With regard to the spread of the disease, the statement occurs that, some months previous, 
the graves of soldiers who had died in 1877 were opened under instructions from Government. 
From that point the present disease began instantly to spread ; at first slowly, in Kiushiu, whence 
it was taken to Yokohama and Tokio by the Hiroshima-Maru. Yokohama itself suffered but 
little, as regards its foreign population ; and in the Chinese portion of the town, where some 2,000 
of this race are crowded in badly constructed dwellings, and abounding in filth, these people 
escaped the disease, as they had done in 1877 , probably because, as then, their drinking water 
was drawn from a source of undoubted purity. Throughout the empire the total cases of the 
disease during the year was put down at 164,274 ; deaths, 97,422 — equal to 59'30 per cent. The 
cases to population, 47"40 per 10,000. 

The circumstance that cholera was absent from Japan from 1861-62 to 1877 is noticed as demon- 
strating that it is not endemic in that country. On the last occasion it was considered that the disease 
spread along the great routes of travel; that the water-supply was the immediate cause of its 
extended prevalence ; and that the towns which suffered most were those situated near the foot 
of mountains, where the custom of directing streams of water through the streets was followed. 
With regard to the results of treatment, the statement occurs that where, as in many of the 
infected places, ' a vast majority of the medical men still follow the Chinese system, the mortality 
has but little exceeded the average of that in more enlightened countries.' The manner in which 
the Japanese dispose of their night-soil is also considered to favour the spread of cholera : their 
system is very similar to that followed in China. 

In discussing the influence of the habits and customs of races on the epidemic prevalence of 
cholera among them. Dr. Simpson wrote as follows : ' In spite of the proximity of this vast 
empire to India, and the fact that it is of much greater extent and twice as populous, 
we find that cholera is comparatively rare in China as an epidemic. In explana- 
tion of this circumstance, reference has been made to the (assumed) fact that the natives of 
China do not drink water of rivers and lakes to the same extent as those of India ; also, that 
the absence of pilgrimages in China leaves the water comparatively uncontaminated. Still 
more potent preventives are no doubt to be found in the fact that the Chinese drink only water 
that has been boiled, and, for the most part, that in which tea has been infused.' 

18 



138 EPITOME OF MEDICAL REPORTS. 

In India excretaa are deposited direct from tlie body on the soil. In China and Japan manure 
is permitted to remain for a considerable time, even weeks or months^ undergoing a kind of 
fermentation before being distributed on the land ; thus (theoretically) the cholera germs are 
supposed to be destroyed^ cholera evacuations being assumed to be dangerous in proportion to 
their freshness — a conclusion not borne out by experience in India. According to the reporter, a 
similar explanation holds good with regard to typhoid fever, a disease comparatively rare in 
China.— (XVIII. 3-36.) 



X. a. QUARANTINE. 

In the Report on Newchwang, April to September, 1872, the reporter observes that in the 
event of small-pox occurring on board ships entering that port, it is cruel and absurd to insist on 
quarantine, for small-pox is never absent from among the Chinese in the neierh- 
bourhood of that settlement. The cooping up of two or three cases of the disease 
does not therefore insure the residents from infection, while the non-infected sailors are made 
thus to endure unnecessary discomfort. Patients also cannot be properly treated under such 
circumstances, and meanwhile their friends and relatives — themselves suffering from the disease — 
attend as usual in their own households or in those of foreigners. He considers that when 
small-pox patients are brought on shore they should be isolated as much as possible; that they 
ought to be brought on shore, and the ship then thoroughly disinfected, — (IV. 27.) 

In the Eeport on Shanghai to 31st March, 1874, the medical officer discusses the subject of 
quarantine in relation to cholera. He writes : 'At Shanghai, with its complex creek communica- 
tions, any attempt to shut out a disease by blocking the river alone must prove 
*"^ *'■ abortive; and unless native as well as foreign vessels are subjected to regulations, 
no actual good could result.' In the event of that disease threatening, he would introduce the 
code of precautions laid down by the Vienna Commission. — (VII. 39.) 

In the Report on Amoy, April to September, 1877, the medical officer discusses the same 
subject. He believes, in brief, that it is impossible to jjrevent the disease, when epidemic, from 
being carried from one part of China to another without putting a stop to trade 
""'■''■ altogether ; the latter would be impossible, as the junk trade cannot be brought 
under regulations. Apart from this, there is the overland traffic j and, according to the Inter- 
national Sanitary Conference of 1874, land quarantine was ' impracticable and useless ' even in 
European countries. It is considered llkdy that in the year under notice the occurrence of an 
outbreak of cholera at Manila was prevented ; but the Spanish authorities by their action put a 
complete stop to trade there ; thus traffic between the island and Amoy was for the time being inter- 
rupted. Another point is also noticed — namely, that on this occasion the epidemic passed over 
Swatow and Hong Kong. Such freaks of the disease are characteristic, although no explanation 
of them transpires. — (XIV. 32.) 

In the Report on Swatow, April to September, 1874, the medical officer, writing on cholera 
which prevailed severely there, observed : ' As to quarantine regulations, he feared 
they were almost useless, unless they are applied to native as well as to foreign 
vessels.'— (VIII. 66.) 



DIPHTHERIA. 139 



XI. DIPHTHEKIA, 



At Peking, during the summer of 1871, diplitLeria was present, although not in epidemic form. 
In its treatment, lime-water and tincture of iodine were used as local applications ' with consider- 
able success.' — (III. 7.) During the period ended March, 1873, the disease 
prevailed to a considerable extent among the Chinese population. The outbreak " °' 

occurred in February. In a particular Chinese family nearly every member was attacked, those first 
seized having been so almost simultaneously, and in them the attack proved fatal. Among foreigners 
■ — even those who were in contact with the family alluded to — no case occurred. — (YI. 11.) 
According to the Report to September, 1874, the disease, although common in the capital, does 
not seem to exist in other parts of China, although similar conditions certainly exist. Dr. 
Dudgeon is unable to find an explanation of this circumstance. He adds : 'No foreigner, if two 
doubtful cases among children be excepted, has ever been attacked with this severe malady.'' 
— (VIII. 37.) In the winter of 1874-75, next to whooping-cough in prevalence and first in 
mortality was ' our old enemy,' diphtheria. The disease chiefly prevailed in the early part of that 
season ; its type very severe, the mortality by it very great. The patients were usually seen on 
the fifth day, by which time little hope of recovery remained. The treatment used consisted of 
carbolic acid, tincture of iodine, lunar caustic, and the removal of false membrane. But the 
treatment does not appear to have been very successful — at all events, few returned to give 
thanks.— (IX. 38.) 

At Tientsin, during the six months ending 31st March, 1873, one case of diphtheria occurred, 
namely, in the person of a child of foreign parents. This was the first of the kind seen among 
foreigners since the port was opened, although the disease has on some rare occasions 
been seen among the native community. — (V. 23.) In the period ending March, 
1876, a severe epidemic of the disease prevailed among the native community. It was charac- 
terized by high premonitory fever, swelling of the cervical glands, with a tendency to laryngeal 
exudation and blood-poisoning. The death-rate was about 25 per cent, of those attacked. — 
(XI. 47.) In the period to September of the same year, three cases of diphtheria came under obser- 
vation, one proving fatal. In it the attack appeared at first to be one of ordinary remittent fever, 
but after a few weeks symptoms considered to be of diphtheria set in, and ultimately ended in 
death.— (XII. 48.) 

At Chefoo, in the period from April, 1872, to March, 1873, two cases of diphtheria were 
recorded, both in children on board ship, the disease fatal in both, although in one of the 
patients tracheotomy was performed. — (V. 16.) In the half-year to March, 1880^ 
' shortly after the subsidence of measles,' many of the natives were attacked with 
inflammatory sore throat, attended in some instances with exudation of false membrane, thereby 
simulating true diphtheria. Some of the families attacked lost two or three of their members. 
-(XIX. 32.) 

At Shanghai, according to the Report for the half-year to March, 1873, only one case of 
diphtheria had ever up to that date been observed there. — (V. 55.) In that to March, 1877, a 
case returned as such is described as having: been ' neither tvpical during life nor on , . 

, P Shanghai. 

examination after death. — (Xlll. 45.) In that to September, 1881, two cases ot 

ll.e disease appear. In reference to them, the remark is made that 'the occurrence of diphtheria, 

hitherto a very rare event in Shanghai, is noteworthy.' — (XXII. 54.) 

18—2 



X40 EPITOME OF MEDICAL REPORTS. l^^liil-J 

At Foochow, in the period from April to September, 1879, there occurred ' some cases of 
diphtheria ; one fatal in twenty hours from the time when it was Erst seen, the rest 
^~^'^°'^- recovered.'- (XVIII. 70.) 

At Amoy, in 1879, two cases of diphtheria occurred, one fatal. These were described by the 
reporter as being the only ones he had met with in China. He has been assured, howerer, 
that among the natives the disease is well known; also that it is very fatal and 
^"°^- much dreaded.— (XVIII. 58.) 

At Yokohama and in Kobe a few isolated cases of ' diphtheritis ' were stated to have occurred 
in the winter of 1876. These bore a strong resemblance to diphtheria, but 'the diagnosis 
between diphtheria and croup was not entirely beyond a doubt.' The spring of 
Japan. ^g.^^ ^^^ marked by an epidemic of diphtheria, both in Yokohama and Tokio, in 
neither place very extensive, and confined to the native population. Subsequent to that date 
epidemics of the same kind have occurred at different places in the interior of the country, so 
that all doubt is removed as to the existence in Japan of the genuine form of that disease. 
—(XV. 54.) 



XII. WHOOPING COUGH. 

At Peking, October, 1874, to March, 1875, a few foreign children suffered from whooping- 
cough after the new year set in, and did not get rid of it till the return of mild weather in 
March. This affection is epidemic at the capital, but always mild in tvpe. The 

Whooping Cougb. . ^ 1, ,1, J J. ^ V, c -i. 

Chinese recognise it as only a lorm ot cough ; they do not seem to be aware or its 
epidemic, contagious, or infectious nature. They call it hsiao, from the sound emitted being like 
the note of water-fowl. Asthma is described as short, rapid breathing without intermission ; 
hsiao, as by turns ending in vomiting. In its treatment, the Chinese employ emetics ; vinegar 
is ordered, but 'cold remedies' are forbidden, the theory being that the disease is caused by 'cold 
enveloping heat.' In diet, ' thin ' articles are to be taken. It occurs in children at the end of 
autumn and beginning of winter. In Chinese works the following kinds of cough are described, 
namely — from wind, cold, heat (internal), damp (internal), excess of water with goose-skin; 
consumptive, from debility, over-eating; food produces mucus, fat pork produces cough and 
apoplexy, and so on. — (IX. 36, 38.) 

At Tientsin, during September, October, and November, 1870, whooping-cough was very 
. ^j^j^ prevalent among the Chinese, and six European children contracted the disease. 
The disease was of a very mild character, and in no case of it were there any 
alarming symptoms jDresent. — (XIX. 5.) 

At Chefoo, in the summer of 1871, a partial epidemic of whooping-cough prevailed, the disease 
having been imported from Shanghai. The only remark made regarding it relates to the 
' peculiar effect nitric acid appears to have in soothing and even cutting short the 
attack.'' The reporter filled a tumbler with sweetened water, and poured in enouo-h 
nitric acid to make it as sour as lemonade. The entire quantity to be given to a child in twenty- 
four hours — the whole containing a drachm of nitric acid. — (III. 41.) In the six months to 
March, 1880, the young native population suffered somewhat from ' an invasion of whoopino-- 
cough.'— (XIX. 32.) 

At Hankow, whooping-cough prevailed as an epidemic in the spring season of 1871. The 



WHOOPING COUGH. 141 

mortality by the disease was small. The weather at the time was mild, and chest complications 
of no consequence. In three out of twelve cases noticed, vomiting was an annoying Hankow 
symptom. Treatment by belladonna was employed. In one case rather severe 
symptoms followed, in the character of scarlatinoid eruption quickly succeeded by anasarca. 
The belladonna was stopped, and all unfavourable syrnptoms gradually ceased. — (II. 47.) 

At Shanghai, according to the Report to March, 1873, whooping-cough, which has appeared 
only within the last few years, is usually of a mild type, and no sequelae occurred in the cases 
that happened. — (V. 55.) In May, ] 880, a lady and six children arrived from 
Hong Kong, bringing whooping-cough with them. The children had cousins in 
Shanghai, who, contrary to advice, visited them. All the cousins took the disease, but as they 
were carefully isolated, it did not then spread. Finally, however, it became epidemic. — (XX. 33.) 
According to the Report to March, 1881, related in turn to each epidemic of measles there was 
an epidemic of whooping-cough ; in some cases the first-named preceding the latter, in another 
set of cases the latter preceding the former. — (XXI. 95.) 

At Foochow, in the six months to September, 1871, whooping-cough occurred among 
European children in the autumn, and at that time the characteristic "■ whoop ' was 
often heard from native children in the sampans. — (II. 27.) 

At Amoy, in the half-year to September, 1871, whooping-cough was ' common 
enough.'— (II. 11.) 

At Canton, during the six months ending 31st March, 1878, one family was attacked with 
whooping-cough, including the mother, a baby of eight months old, and two children aged respec- 
tively six and seven years. After three months, they all recovered. The cases 
were treated, in that of the infant by belladonna, in those of the two children with 
chloral. The conclusion arrived at, however, is that the disease will run its course irrespective 
of treatment, although antispasmodics are very necessary. With reference to these attacks, the 
circumstance is noticed in the Reports that no other children were affected, — (XV. 13.) 



XIII. MUMPS. 

At Peking, in March, 1876, there prevailed a good deal of mumps, with sore throat and swell- 
ing of the glands of the neck. Native and foreign children suffered from these 
affections. An alum or vinegar gargle, fomentations or inhalations of steam, " '°^' 

gave relief. The causes of these diseases were stated to be sudden changes of temperature 
and N.W. breezes.— (IX. 38.) 

At Hankow, in the period from October, 1872, to March, 1873, parotitis was the only affec- 
tion that prevailed as an epidemic. The disease was mild in character, and the 
cases presented no instance of metastasis. In the Roman Catholic Orphanage forty 
children and one adult were attacked by it. — (V. 31.) 

At Shanghai in the half-year to March, 1877, there was, among children, ' an epidemic 
of what would have been mumps if the glandular swelling had been attended 

-in X- /VTTT A A \ Shangliai. 

by fever, which it was not m the cases that came under notice.- -(Xiii, 44.) 

At Foochow, in May, 1880, an epidemic of parotitis prevailed, chiefly among the 
Chinese, but affected also four of the European resident population. — ^^^^^^„_ 
(XXT. 54.) 



142 X EPITOME OF MEDICAL REPORTS. 

At Amoy, in the six months to September, 1871^ mumps, like whooping-cough, ' was common 
enough.' — (II. 11,) In January, 1872, a trivial epidemic of that disease prevailed 
among the Chinese, and also attacked a few Europeans. The disease is usually 
common at the beginning of the year. — (III. 22.) 

At Hoihow, in the half-year to September, 1881, many cases of mumps occurred 
among the Chinese, adults as well as children being subiects of attack. — 

^°^''°- (XXII. 9.) 

XIV. INPLTJENZA. 

At Swatow, during the summer of 1870, a somewhat peculiar epidemic of influenza appeared. 
It attacked the children living on one side of the river, those on the opposite side, and on Double 
Island, being unaffected by it. It first occurred in a particular house, in a child 
twenty months old ; its symptoms, " running at the eyes and nose, feverishness, 
general malaise and loss of appetite — at the end of five days a sharp bronchitic attack, then 
lessened fever, gradual resolution, and recovery in about ten days." The second attack occurred 
in a boy five years of age ; it began in the same way, ending in a sharp attack of laryngis- 
mus stridulus and bronchitis, recovery taking jDlace after ten days. The disease attacked all 
the children living on the south side of the river, and affected all in the same way as here 
described. It only attacked children ; and the reporter states that he had previously seen nothing 
similar to it, although sporadic cases of influenza are not uncommon. — (XVIII. 75.) 



XV. SEPTICEMIA AND PYEMIA. 

At Shanghai a case of septicemia occurred in January, 1880. The subject of it, whilst 
examining the mouth of a cow in the last stage of typhus, was spattered with some of the fetid dis- 
charge therefrom by the animal coughing. He received a portion of the matter 
into his mouth, the stench from which induced violent attempts at vomiting. 
Shortly afterwards the mouth was rinsed with brandy. The next day sharp pain attacked the 
mouth and head ; these were at first attributed to neuralgia. Two teeth were extracted, but without 
benefit ; on the contrary, symptoms increased in severity. Fourteen days after the poisoning the 
cheek was much swollen, the saliva thick and stringy, the breath fetid ; on the right side the 
anterior pillar, gums, and outer border of the tongue were covered with scattered ulcers, some 
bright red, some with a greyish-white centre j the glands were little affected, and there were no 
general symptoms. Fuming hydrochloric acid and honey were applied, but with difliculty, as the 
swelling prevented the jaws from being opened. Chlorate of potass was given in large doses, 
coal-tar saponin, with carbolized washes, being used locally. In some days a few of the ulcers had 
cleared ; soon they manifested themselves afresh, occurred also od the opposite side, and with 
greater intensity ; the breath became intensely fetid, salivation profuse ; the patient in con- 
sequence had to remain in a sitting position; the local pain intense. Sloughing now set in; the ulcers 
left as sloughs separated became covered with whitish coating, but showed no tendency to heal. 
Indurated schirrhus-like nodules appeared in the mucous membrane of the cheek. Then they began 
to slough, the sphacelated pieces having a cadaveric odour and putrid bloody discharge. The 
general symptoms were such as betray profound blood-change; pulse small and irregular, skin 
dry, temperature not excessive; from time to time profuse fetid diarrhoea; sleex)lessness. The 



SEPTICEMIA AND PYEMIA. 143 

loss of substance caused great debility j health was broken, and after lingering to 18tli July he 
died.— (XX. 36.) 

At Amoy, in hospital, according to the Report to September, 1876 : ' Pyemia, erysipelas and 
allied diseases were fortunately rare, notwithstanding the imperfect sanitary ^ 
condition in the native hospital.' — (XII. 39.) 

At Yokohama, according to Dr. Simmons, the diseases which mostly occur as the consequences 
of injuries or surgical operations are pyemia or septicemia, erysipelas and tetanus. All of these 
may, however, occur independently of mechanical injury or surgical operation. 
They have but seldom attacked foreigners in Yokohama; and this applies to 
hospital equally with private practice. The remark occurs that in China also pyemia is of rare 
occurence ; and it is added, ' Climatic conditions have more to do with the causation or propagation 
of diseases of this class than has been admitted of late.' — (XV. 69.) 

XVI. EETSIPELAS. 

At Peking, in the half-year to September, 1871, a considerable tendency to erysipelas 
during the spring season was observed both among foreigners and the native Chinese inhabitants. 
— (III. 7.) In the Report to March, 1875, Dr. Dudgeon noticed the infrequency 
of erysipelas at that capital, and stated that at some of the treaty ports the 
disease is not met with at all. He contrasts this immunity from the disease with the frequency 
with which it occurs in the west, and observes that when it occurs in China it usually does so 
after the slighter, not the more severe operations. The name given by the Chinese to the affection 
is ta-t'ow-w6n. In warm winters it is so frequent as to be considered epidemic, being then caused 
' by the poison of the seasons.' A variety named lii-s%e approaches diphtheria ; in it the neck is 
greatly tumefied. — (IX. 39.) 

At Chefoo, in the period to March, 1872, a case of erysipelas occurred and proved fatal. 
The patient, a strong man of regular habits, had suffered two or three days from a severe cold. 
By the constant use of the handkerchief he had set up slight irritation of the tip 
of the nose ; this became accompanied by fever, and showed a tendency to spread ; 
when first seen he lay in bed deeply comatose, and exhibiting all the worst symptoms of facial 
erysipelas extending to the brain. He died twenty-four hours after noticing the irritation at the 
tip of the nose and feeling feverish. — -(III. 38.) 

At Kiukiang, in the six months to March, 1882, five cases of phlegmonous ery- 
sipelas of the lips were seen at the hospital, the disease fatal in all. — (XXIII. 39.) 

According to the Report of Chinkiang, April to September, 1877, erysipelas was epidemic at 
that place during the summer months of that year, and continued prevalent at 
the end of the period. The remark occurs, however, that the disease presented no 
feature calling for special note. — (XIV, 64.) 



XVII. EHEUMATISir. 

At Hankow, in the six months to September, 1872, there occurred 360 cases of chronic 
rheumatism. The acute form was not met with, and rarely heard of. That „ , 

. in Hankow. 

which prevails is assigned to generally impaired health, the combined result of ma- 
laria, bad diet, damp dwellings, and in certain seasons rapid alternations of temperature. The 
disease was met with as often during the hot months as during the cold. — (IV. 75.) 



144 EPITOME OF MEDICAL REPORTS. 

At Foochow, to September, 1871, rheumatism in all forms and degrees prevailed among 
foreign sailors, but acute, or rbeumatic fever, was rare. The alkaline treatment, sound in theory, 
was not very successful in practice. The hypodermic injection of morphia was 
recommended. The affection was frequently connected with venereal disease. — 
(II. 31.) In the Report for the six months to March, 1876, details are given of a case of 
rheumatic fever with endocarditis occurring in a Roman Catholic missionary just arrived from 
Formosa. He so far recovered as to be sent away to his native France. — (XI. 40.) 

In the period to September, 1877, one case of acute rheumatism occurred. It was treated by 
salicin in 20 grain doses every two hours, and afterwards every three hours. The reporter was 
very much pleased with the result. He remarks upon the ' trouble ' — in the treatment of 
rheumatism — there used to be in the old days with the old remedies. — (XIV. 86.) 

According to the Report to September, 1879, the form of rheumatism which most prevails at 
this settlement is the chronic, although a few cases of rheumatic fever have been met with. A 
mild form of rheumatic gout is not entirely absent. Three cases of rheumatism of the sphincter 
ani and adjoining parts of the perineum came under notice ; they occurred in men subject to 
ague, and were very distressing. — (XVIII. 67.) 

At Swatow, during the six months to September, 1879, three cases of acute rheumatism — • 

rheumatic fever — occurred, namely, two in sailors arrived from the north, and one in a resident 

— in the latter supervening on a severe wetting. ' They all yielded quickly to the 

exhibition of salicin in 20 grain doses every four hours, the effect of the medicine 

being most marked in the case of the resident, an oldish man (48 to 50 years), very much broken 

down in health.'— (XVIII. 76.) 

At Canton, in June, 1877, treatment of a case of acute rheumatism by means of salicin was 

tried. After 160 grains of the drug had been taken the pains began to subside, and in eight 

days from the first administration of the drug the patient could walk, though with 

a little limping, from which circumstance, the medical officer says, ' it is reasonable to 

attribute the rapid disappearance of the pain and fever to the salicin.'— (XIV. 59.) 

This disease occurring in the joints, and in the acute form, is very uncommon at Yokohama, 
either in natives or foreigners. In both these classes, however, the less important 
rheumatic affections are not unfrequent. Gout is considered to exist in Japan, in 
the same class of persons and in the same proportion as elsewhere. — (XV. 56.) 



XVIII. VENEKEAL DISEASES. 

The Chinese term for sy]]h'dLS is t'ien-pao cJnvang, or yang-mei. It is classed with /ai or leprosy. 

The treatment adopted in China for this disease during the last 2,000 years corresponds very 

„. , exactly with our modern Western therapeutics. Calomel, cinnabar, and 

Historical. , . t n n n n 

realgar are among the recognised formulee, the former entering into every 
recipe. Prescriptions are given also to drive out the 'poison of the calomel,' after it has 
effected a cure; among them is t'n-fu-ling or China-root, or radix smilacis. The Chinese 
popularly believe that salivation is the poison of syphilis flowing out. Not only are the preparations 

of mercury used in the treatment, but some of the most approved methods of the pre- 
'"ment.""' " ^S"*' ^^J ^'^'^^ ticeu SO from time immemorial ; for example, fumigations and vapour 

mercurial baths, both local and general. As an effective fuming prescription, the 
following is given, namely: lead and mercury, ua. 1 mace; cinnabar, ju-hiaug (olibauum), 



VENEREAL DISEASES. 145 

mjvrh, aa. 5 candareeus ; dragon's blood, realgar, c/i'eVliiang (wood of Aquilai'ia agallocha), 
lign aloes, aa. 3 candareens — to be pulverized, wrapped up in paper to form a wick, and put into 
a lamp. The patient to be covered over, and while undergoing this vapour-bath successive 
mouthfuls of cold water are to be taken and frequently renewed as it becomes warm. The 
inhalation is to be through the nose, and the object of the cold water is to preserve the teeth 
from the influence of the mercurial poison. Another prescription is lead (carbonate), and 
fuligo (soot), aa. 1 mace ; black lead, 8 candareens — to be fused with mercury, 1 mace, and formed 
into cakes, to which is added yinchu, or spurious cinnabar, and calomel, aa. 1-J* ounce; alum and 
realgar, aa. 1 ounce — to be made into a mass with jujubes, and afterwards divided into sticks 
or pills J one pill to be put into a small charcoal furnace or stove, and the patient to blow it 
with the head covered. Using this remedy for four or five days, salivation sets in, and so 
the poison is supposed by this means to be driven out of the system. This is termed the 
'blowing or puffing prescription.' Another is called the ' contemplating remedy.' In this the 
patient is put into a barrel and smoked in the same way. To remove syphilitic blotches, 
alum and rhubarb in equal parts are mixed with water ; with this the affected portion is to be 
rubbed, and the stain disappears. In the treatment of the syphilides the same course is 
pursued, the notion being that secondary and tertiary symptoms are not so much a further 
development of the disease as the calomel ; or at all events, the disease having been cured by 
the use of mercury, there ensue other diseases, or bad ulcers of the palm of the hands (psoriasis 
palmaris). The book name for affections of the geuito-urinary organs generally is shan. — 
(IX. 40, 42.) 

At Peking, in the period to March, 1875, syphilis was not by any means a rare affection, even 
among the better classes of Chinese. The Mongols seem to have a worse type of 
the disease than the Chinese, and to be less amenable to treatment than the latter, 
this being due to their more filthy habits. — (IX. 42.) 

Tientsin, to September, 1873, had always been remarkably free from enthetic diseases. In 
the six months to that date, the cases recorded had all been brought from the 

. ° Tientsin. 

south, and on board H.M.S. Curlew stationed there no single case occurred. — 
(VI. 52.) 

At Kiukiang, in 1871, syphilis in very horrible forms and of great severity prevailed; so did 
venereal diseases of all kinds, details of which occur in the Report on that place. 
In some of the cases related there is evidence that the discharge from a suppurating 
bubo does not drain off the syphilitic virus, as believed by some writers. — (II. 65, 66.) 

At Hankow, to March, 187:^, the following particulars of a case occur : 'A. B., ^t. 40, had 
suffered from syphilis in his youth ; contracted a recent chancre, which healed up without hard- 
ness or distinct enlargement of the glands. Prom the woman who had communicated 
the disease, another adult at the same date contracted a hard chancre, succeeded by 
an ordinary course of syphilis.' The reporter remarks that this case is of interest, as an example 
of venereal contagion in a person who had previously passed through an attack of syphilis. He 
notices that complete immunity for the future is generally acquired when the system has been 
once impregnated with the poison of syphilis ; but cases are recorded (Hill on ' Syphilis,' p. 28) 
where the symptoms have recurred in regular order. — (III. 47.) 

According to the Eeport for the period from April to September, 1872, there presented them- 
selves for treatment 331 cases of venereal disease in one form or other, the subjects being 
Chinese. It is recorded that the majority of them were married men, and either living with their 
wives, or in the habit of visiting them if at a distance, while the progress of the disease was still 

19 



146 EPITOME OF MEDICAL REPORTS. 

unchecked. The prevalence of syphilis among the lower order of natives is alluded to, and it is 
noted that of the above cases, 31 were of the hereditary form of the affection, the patients in 22 of 
the number being infants of less than two years of age. — (IV. 75.) 

In the Report from October, 1880, to March, 1881, Dr. Begg mentions the occurrence there 
of a form of disease not met with in England. It is called ' a tubercular syphilide/ for want of a 
better name. It seems to be a low form of inflammation in the cellular tissues, giving rise to 
subcutaneous ' cold ' abscesses of small size, but multiple. Its natural course is to discharge by one 
or more openings, and then to cicatrize, leaving a sensitive cicatrix. Sometimes the matter 
burrows for long distances under the skin, and involves a large tract. The result of these cicatrices 
is at times great deformity, and occasionally immobility of joints when, as is often the case, the 
disease is in their vicinity. The contents of some such abscesses, especially when situated near the 
anus, are of more consistency, and even in some cases cheesy in character. The most common situ- 
ations are the arms, shoulder, knee, thorax, and neck. The patients are generally young adults, 
otherwise in good health. A history of syphilis is not obtained in all. The treatment most successful 
is by iodide of potash, painting with iodine, free incisions, and dressing with carbolic oil. — (XXI. 47.) 
At Shanghai, in 1871, the public women and brothel-keepers expressed their willingness to 
submit to regulations which provided for the establishment of a Lock Hospital, house to house 
^ . visitation by a Chinese doctor, etc. This remark applies equally to the French 
settlement and to the English. The natives observe that it is only since direct 
trafiio by land and sea with the south has become easy that syphilis and leprosy have spread in 
the district.— (II. 35.) 

Steps were taken, during the half-year ending 31st March, 1872, for the establishment of a 
Lock Hospital. The reporter alludes to the ' experiment of brothel suppression ' having been 
tried, but with the most disastrous results : that in 1845 Bei-lin brothels were closed, and in 1848 
the amount of disease and illegitimacy were found to be greater than before. In one shape or 

another, venereal disease attacked seven men of the foreign community during the period. 

(III. 79, 85.) 

According to the Report to September, 1872, venereal disease ' very seldom realizes the 
sensational description of its ravages by many naval and military surgeons who have written of 
syphilis in the East.' These affections, however, gave 14 per cent, of the admissions by all causes 
during the period.— (IV. 100.) 

On the 1st of January, 1877, a Lock Hospital for the settlements was opened, and compulsory 
inspection of public women introduced. This was a revival of an institution established on the 
voluntary system seven years before, but which had failed, partly through lack of funds, partly 
through the inveterate objections of the women concerned. Bnthetic diseases are neither 
remarkably prevalent nor remarkably severe at this place. — (XV. 4, 5.) 

According to the Report to March, 1879, a decrease in admissions by venereal diseases as 
compared with 1877, occurred. As results of the introduction of the Contagious Diseases Act 
public women devoted increased attention to their clothing and personal appearance. A good 
deal of difference of opinion, however, at that time existed in relation to the advantages conferred 

by the Act. It was stated that there are districts in China as yet free from syphilis 

(XVIL 18.) 

In the six months ended March, 1881, Dr. Jamieson states that various accidental sources of 
danger in regard to the conveyance of syphilitic infection exist, and are fostered by the dirty 
habits of the native Chinese. Among them he enumerates cheroots and the operation of shavino-. 
In reference to the latter, he alludes to two cases of a similar kind quoted from Desprcs in the 



VENEKEAL DISEASES. 147 

London Medical Record, 1881, page 160. He relates the risk also incurred through the opera- 
tion of tattooing in Japan, and quotes a statement by Dr. Simmons, that three out of four of the 
urban population of Japan are syphilitic. — (XXI. 94, 95.) 

At Ningpo, according to the Eeport for the half-year to March, 1878, gonorrhoea was then 
more prevalent than usual, the increase assigned to the unusually frequent visits of 
war-vessels of various nationalities. No case of syphilis, however, came under 
notice during the period. — (XV. 21.) 

At Wenchow, 1877-78, ' enthetic disease was very plentiful; the ecclesiastical tendencies of 
the place serving to favour its spread, as the nuns are merely prostitutes, and are, as a rule, 
diseased. Their favours are largely sought, notwithstanding a comparatively high ^ ^^^ 

fee, and the general knowledge of their infected state. There are about forty 
convents, besides several brothels containing avowed prostitutes ; and it is stated that domestic 
morality stands very low, many married women being notoriously dissolute. The wide spread of 
syphilis is by all this easily accounted for.' — (XV. 41.) 

At Poochow, 1871, enthetic diseases directly or indirectly cause the large proportion of sickness 
among sailors. Under the Merchant Shipping Act, the men affected have to pay for 
treatment on account of these diseases j this leads to their concealing the primary 
attack. In 1869, an order was issued prohibiting sailors fx'om going on shore, and as a result 
venereal diseases declined among them. — (II. 31.) 

In the half-year to September, 1872, the good effects of the order referred to were mentioned 
by the medical oiEcer. He noticed that of 67 cases of venereal disease — namely, 16 of 
syphilis and 51 of gonorrhoea — only 3 occurred locally; all the others were imported. — (IV. 63.) 

In that to March, 1873, a case is related in which a chancre, at first taken to be a soft sore, 
healed with considerable induration accompanied by glandular enlargement in the groin, so like 
the non- suppurating bubo of hard chancre as to lead the medical ofiicer to think he had mistaken 
the character of the sore in the first instance, and to place the patient under constitutional 
treatment. In a few days, however, the bubo showed signs of suppuration, was poulticed 
and opened, ' thus proving the non-infecting nature of the sore.' Had the gland not suppurated, 
he would have pronounced this an infecting chancre {vide Kicord in the Lancet, of August 17th, 
1872).— (V. 39.) 

In the period to September, 1879, no case of the severest form of venereal disease has been met 
with unless contracted at the anchorage in one of the outside ports. Sloughing phagedena of 
the privates of the worst kind, and destruction of the velum palati, pillars of the fauces, scalp, 
face, and gastrocnemeus through the action of the specific sore, have been met with ; but all such 
were imported, not originating in Poochow. The reporter is of opinion that the type of 
venereal sore familiar to the settlement is very mild. He states that ' touching conclusions to 
be prognosed from the primary sore, one would make a mistake if he anticipated no harm from 
the absence of hardness. He has known very evil consequences to arise from the neglect of 
what seemed a slight superficial chap.' He adds : ' The old rule about the Hunterian chancre 
alone being harmful fails completely in China.' — (XVIII. 69.) According to the Eeporfc 
to March, 1881 : ' Syphilis is rife in all degrees of virulence ' at Poochow. — (XX. 52.) 

At Amoy, according to the Eeport on that place to September, 1871, no case of syphilis 
occurred among the residents. In dispensary practice there were treated 36 cases 
of gonorrhoea, 8 of primary sores, and 26 of constitutional syphilis. It is stated 
that ' ten per cent, of the population are syphilitic, and the lepers are no exception.' — 
(II. 12, 23.) 

19—2 



148 EPITOME OF MEDICAL REPORTS. 

In the Eeporfc on that place for the six months to March, 1873, an 'epidemic ' of syphilis is 
described. In the crew of a gunboat at the settlement a large proportion of the men contracted 
the disease, namely 25 out of a strength of 70. The vessel had been on the station during the 
previous nine months, and no unusual restriction placed on the sailors as regards going on shore. 
A considerable number of the ulcers were hard chancres ; these, when they occurred in men of 
good constitutions, were very amenable to mercury. According to the medical officer, 'syphilis 
can be stamped out by very simple measures.' These measures may meet with much opposition 
in many parts of Europe, but here, where on such subjects unglozed facts have made people 
more latitudinarian, there can be little to hinder the adoption of measures calculated to check, 
and finally eradicate, the disease. — (V. 7.) 

In the Report to September, 1873, a statement occurs that the ' epidemic ' of syphilis above 
alluded to had subsided, but that lately two cases of very intractable phagedenic ulcer had come 
under notice. — (VI. 20.) In that for the period from October, 1880, to March, 1881, as is the case at 
most large seaports, syphilis is extremely common. There are no regulations in force tending to 
check its spread, so that the notorious immorality of all classes has brought it into almost every 
family.— (XXI. 27.) 

At Takow, during the period to September, 1871, in reference to a case of tertiary syphilis in 
the person of one of the aborigines, the statement occurs that his wife and several members of 
his tribe appeared to be suffering from the same disease. — (II. 68.) In the corre- 
sponding period to March, 1873, an unusual amount of syphilitic disease prevailed 
among the shipping population during the sis months. Almost all the vessels came from Amoy. 
— (Y. 26.) According to that to September, 1873, among the 'savages' of the east coast of 
Formosa, syphilis is of very frequent occurrence. — (VI. 40.) 

At Swatow, 1871, syphilis in all forms prevailed generally in the population — from simple 
chancre to most severe tertiaries. All forms and stages have been met with, co-existing in the 
same person — gonorrhoea, gonorrhoeal rheumatism, sloughing chancre, rupial 
eruption, periostitis of tibia and sternum, and syphilitic fissures of rectum. The 
medical officer strongly advocated the introduction of a Contagious Diseases Act, to be enforced 
under the co-operation of the Chinese authorities. — (II. 8.) In the period to September, 1872, the 
Report states that again : ' Every form of syphilis came under observation,' among them cases of 
sloughing ulceration of tonsils and fauces, periostitio affections of the tibia, rupial ulceration all over 
the body, and occasionally total destruction of some organ from sloughing phagedena. — (IV. 88.) 
During theperiod to September, 1874, syphilitic diseases of all forms continued to be numerous. The 
medical officer remarked that 'Here we are much addicted to mercurial vapour-bath and Plummer's 
pills' in their treatment. — (VIII. 66.) In the period to September, 1876, enthetic diseases stood 
first in severity and importance. They were almost entirely confined to sailors. Many of the 
cases illustrate the difficulty of predicting whether any given sore seen for the first time will be 
followed by constitutional symptoms, or, though not syphilitic, will take on phagedenic action; 
whether it will heal without difficulty or delay, or give rise to troublesome buboes. What 
appears at first to be a soft chancre sometimes develops in a few weeks into an indurated sore 
with constitutional sequoias ; there may be hardly any induration at the site of a sore, and no 
induration of the inguinal glands, and yet syphilis manifest itself in all its severity. Dr. Scott 
has ' never seen an indurated lump on the prepuce, and indurated glands in the groin and neck 
of any person who, sooner or later, did not show other symptoms of syphilitic disease.' — 
(XII. 21.) 

At Canton, according to the Report for the eight months ending March, 1883, syphilis prevails 



N^ENEREAL DISEASES. 149 

to a frightful extent, and 'we can only hope for a remedy for this evil when laws which 
govern inspection of prostitutes in some of our Western cities have force here.' 
—(XXIII. 33.) ^'"*°°' 

According to statistics given, there has been a marked diminution in the prevalence of syphilis 
in Yokohama since Government undertook the medical supervision of prostitution. For a time, 
however, it would appear that one result of this supervision was a very great 
increase in secret prostitution, chiefly in connection with sailors' taverns. The ^^'"'' 

more inveterate forms of the disease — namely, secondary and tertiary — are also of frequent 
occurrence, both among natives and foreigners; a considerable proportion of such oases, how- 
ever, occur in persons as results of primary syphilis contracted elsewhere. Contrary to usually 
received opinion, syphilis among natives in Japan is of an exceptionally mild form, the more 
severe and deeper lesions rare. This comparative immunity from the graver effects of the 
venereal poison is somewhat paradoxically believed to be due, at least in part, to the long- 
continued general and unrestrained diffusion of the disease. It is as though the blood of the 
nation, either directly or by inheritance, had become more or less infected by the poison ; and this 
circumstance, in compliance with a law which applies to most infectious diseases, if it does not 
prevent the contraction of new infection, at least modifies the effects of the contagion. Similar 
observations have been made in other countries in which syphilis has been allowed to run riot, 
more especially in Portugal, where the comparative immunity of the natives was noticed as long 
ago as the Peninsular War. But the fact that the disease is of a mild type in the natives by no 
means ensures that it will be trifling when acquired from them by a foreigner; and it is as a rule 
more severe in the European than in the already more or less syphilized natives. Still, even among 
foreigners, the disease is neither more severe nor less amenable to treatment than when occurring 
in Europe or America. — (XY. 56.) 



XIX. CANCEE. 

The Chinese, as a rule, are ignorant of the nature of cancer, and class it among the ordinary 
ulcers. Cases of the epithelial form of the disease occurring in them are related 
by Dr. Dudgeon in the Report on Peking to March, 1875. — (IX. 42.) *■■ 

In the Report on Amoy, April to September, 1876, Dr. Watson records twenty-seven cases of 
cancer among natives as having been seen at the Chinese hospital in twelve months. He describes 
a form of dysphagia as of frequent occurrence among the native residents of that 
place, and, in the absence of post-mortem evidence, assigns it to cancer of the 
oesophagus. — (XII. 38.) In that to September, 1878, a case of 'secondary cancer of the sub- 
maxillary glands followed an epithelioma of the lower lip excised some months before. — 
(XVI. 12.) 

In 1880-81, Dr. Manson alludes to the occurrence of keloid in the lobes of the ears of women, 
as he considers, from the irritation caused by their earrings. He has seen tumours of this nature 
of a size larger than walnuts; he has noticed the circumstance of their arrangement being sym- 
metrical, as if the skin on each part of the body had local peculiarities. The liability of cicatricial 
tissue to assume a keloid character in the dark-skinned races is well known. The Chinese in this 
respect probably occupy a position intermediate between the black negro and the white European. 
—(XXI. 35.) 



150 EPITOME OP MEDICAL REPORTS. 



XX. LEPROSY. 



In the Eeport on Peking to March^ 1875, Dr. Dudgeon gives an abstract of Chinese views on 

leprosy. This disease is called ta-ma-fSng. In books the names ta-fSng-chchw'ang and hi are 

met with. Mange in the dog is termed lai. Leprosy arises from three sources — 

opi'nions. climatCj infection^ and defective nutrition. Five different forms of the disease are met 
with. In one the skin dies, indicated by loss of sensation ; in the second the flesh dies, 
and no pain is felt in cutting it ; in the third the blood dies, and ulceration and pus are formed ; 
in the fourth the tendons die, and hands and feet drop off ; and in the fifth the bones die, the 
nose is destroyed. Along with this, the eyes, lips, and throat become involved. Among the 
causes specified is ' the air of graves.' The hereditary and infectious nature of leprosy is noticed- 
The ancients called this disease lai-feng, or li-feng, on account of its malignity. In the treatment 
it is recommended that lepers shall live alone, and attend to their proper nourishment, avoiding 
all ' forbidden things ' such as salt, fish, pork, also beef, horse, donkey, or mule flesh. When 
leprosy begins, it resembles pityriasis versicolor, and white skin falls off from the whole body, 
' like a serpent casting his skin.' The sovereign remedy for lai consists of the leaves of Xanthium 
strumariwn. One prescription to be taken on the first day of the treatment consists of ]pai-cliih 
(an umbelliferous plant, perhaps angelica), scorpions, and ginseng ; on the second day, rhubarb, 
the root of amomum, and chan-t'ui (feet of locusts), aa. 1 tael, 8 mace; tsao-kioh-tze (semiuse 
gleditschise sinensis), 1^ tael: mix. Take 5 or 6 mace, and ta-feng-tze yu (oil from the seeds of 
chaulmugra, Gynocardia odoratd), IJ mace, a little saltpetre, a bowl of spirits, all of which is to be 
taken. Should there be abdominal pain or diarrhoea, rice is to be taken. Persons below fifty years of 
age may take the above prescription; beyond that age it is not ordered. Yery strong persons may 
take such a dose three times in ten days. On the third day of the treatment a tonic regimen 
is ordered, and the following is the prescription : Ti-lm-p'i (cortex radicis lycii), Imig-kieh (salva 
[salvia ?] plebeia), li'u-shen (rad. robiniee amarae), si-sin (heteropa asaroides), aa. 2 taels ; to this rub 
in 2 taels each of kwan-chung han-shui-shih (stone from cold water ?), sulphur, alum, she-chwan-tze, 
with 5 mace of saltpetre : mix, and add lard to the whole. Ta-feng-tze-yii is so called on account 
of its virtue in curing leprosy. A case of tubercular leprosy was recorded. It occurred in a 
Chinaman, thirty-five years of age. The disease began three years previously. A second case 
was noticed. It happened in a woman, and took the form of immense enlargement of the foot, 
with ulceration.— (IX. 29, 30.) 

At Chefoo, in the period to March, 1872, ten or twelve cases of leprosy occurred, presenting 
the ordinary features of the disease. In two of these the influence of damp in causing the affec- 
tion could be traced. In the way of treatment, cleanliness, avoidance of damp, good 
clothing and good food, with iron and vegetable tonics, were recommended. Dr. 
Myers, quoting from a Bombay paper, suggested that patients anoint themselves with a solution 
of one part of carbolic acid to eighty or one hundred parts of sesamum oil. — (III. 40.) 

According to the Report on Kiukiang for the year ending 31st of March, 1881, among 1,420 

native patients, only 3 cases of leprosy were met with, none of them belonging to that 

place ; and as the natives of Kiukiang are a fish-eating population, the hypothesis 

that fish (putrid) plays any important part in the production of that disease is, 

Dr. Jardine thinks, untenable. — (XXI. 49.) 

At Hankow, 1871, of 57 cases recorded, 55 were in males and 2 in females. The disease chiefly 
affected residents in the country ; with scarcely an exception, poverty and hardship had been the 



LEPROSY. 151 

general lot of those affected j the greater the poverty the more numerous the cases of 
leprosy. In places where it prevails it has for several generations declared itself 
in particular families connected by ties of consanguinity. When the disease becomes 
established after puberty, the sexual functions become weakenedj and in the majority of instances 
soon destroyed. The sons of a leper father being for the most part born while the disease is 
latent, may escape the taint, or the predisposition may be so mild that if placed in more favoured 
circumstances they may partially or completely combat it. Leprosy contrasts with other trans- 
missible disorders by limiting the number of its subjects through weak generative power ; custom 
also decries the marriage of a leper, and sanctions the separation of a wife when the malady declares 
itself. It is not dependent on the same circumstances of soil and vegetation as natural diseases ; in 
many parts of the world where these are endemic, leprosy is absent, while the leprous diathesis is 
all-powerful in other regions which are non-malarious. Seeing that it is a degeneration which 
flourishes amidst a variety of climates, of soils, of staple articles of food, and of race, it cannot 
be attributed to any specific defect in one of these ; yet it does not take root in a population 
without an unfavourable conjunction of several of these conditions. At Hankow the disease has 
occurred in three native immigrants after residence of 10, 12 and 19 years, while their brothers 
and sisters who remained in their own part of the country escaped. 

Unlike syphilitic poison, that of leprosy has no power of self-augmentation in the system or 
of perpetuating itself by transference to the healthy. In that it clings to families it resembles 
a diathesis like the scrofulous, which may remain latent or be brought into activity by a variety 
of depressing circumstances. — (II. 55.) 

In the Eeport for the six months to September, 1872, particulars are given of eight cases of 
leprosy in its ansesthetic form, and as elephantiasis. — (lY. 77.) In that to September, 
1875, Dr. Eeid gives details of some cases of leprosy treated with Gurjun oil 
(Dipterocarpus), the result being that in that drug ' Dr. Dougall has discovered a 
remedy highly beneficial in alleviating the skin manifestations ' of that affection. Ee- 
garding the question of contagiousness. Dr. Hansen has recorded several cases where the 
family history for two generations was free from taint, and where he could assign its origin to 
contagion. A few lepers are found in the cities, but not, as far as Dr. Eeid is aware, among 
families who have resided in towns over two generations. The majority of cases come from wet, 
aguish country districts where the inhabitants are collected in small hamlets, are extremely poor, 
subsisting on the produce of uncultivated lands, and partaking only occasionally of fish or flesh 
meat. Many of the offspring of lepers escape the disease, although all are alike exposed to 
contagion. Phthisis frequently exists in leprous families. Alluding to the statement by Dr. 
Liveing that leprosy is not found in China north of the Yangtze-kiang, Dr. Eeid writes : ' This 
may be so as regards some of the provinces through which the river flows, but it does not hold 
good in Hupeh, for the disease extends along the banks of the Han in a northward 
direction.'— (X. 48—52.) 

At Shanghai, in 1871, it was observed that leprous women very frequently suffer from 
amenorrhoea and leacorrhoea. No connection was traced between the occurrence of leprosy and 
residence in a particularly aguish district, nor does syphilis in the parent or indi- 
vidual himself appear to act as an exciting cause. Yet it is only since direct traffic 
by sea and land with the south has become constant and easy that syphilis and leprosy have 
spread in the Shanghai district. The results of treatment have been unsatisfactory — arsenic, iron, 
iodide of potassium, cod-liver oil, improved diet, etc., arrest the progress of the disease, but do 
not in the least tend to cure it. — (II. 42.) 



152 EPITOME OF MEDICAL REPORTS. 

Dr. Macgowan, of Wencliow, gives a record of epidemics of different kinds, which, according 
to Chinese writers, have prevailed in China within historical times. According to that record leprosy 
has on four different occasions prevailed as an epidemic; namely, in 1417, during 
the fifth moon, epidemic leprosy prevailed in Kinhua; in 1589, the disease pre- 
vailed over several districts, preceded by unprecedented rains ; iu 1590, it reappeared in 
Hsiaoshan, a district of Hsianhsing; and in 1591 it was epidemic in the Changhua district, 
Hangchow. On each of the three last occasions it prevailed during summer. Adverting to an- 
other epidemic of leprosy not included in the above record, namely that of 1558-59, it is observed 
that the sudden and apparently unprecedented outbreak on that occasion was remarkable from 
the fact that the disease is seldom met with in Chehkiang, and never perhaps in the northern part 
of the province. Fukien to the south, and yet more in Canton, farther south, are the seats of 
this malady. Shaohsing, however, is remarkable for the prevalence of elephantiasis of the leg.— 
(XXII. 24.) 

At Amoy, in 1871, leprosy prevailed extensively. Of patients applying at the native hospital 
7 per cent, suffered from some form or other of it. The lesions of the disease were not distributed 
so symmetrically as in syphilis. In the generality of instances several forms are 
present, but always anassthesia. The parts affected most frequently are, in their 
order, the arms, hands, face, legs, feet, thighs, neck, abdomen, chest, back, genitals. Of fifty-sis 
cases, thirteen were assigned to hereditary taint, four to infection; in five there was a history of 
syphilis, although no other connection between these diseases. That leprosy is hereditary, few 
doubt ; that it is infectious, few believe. Yet a leper marries a healthy woman ; a year afterwards 
she also becomes a leper. — (II. 14.) 

In 1881, Dr. Manson wrote : " Leprosy has laid a firm hold on the people. Large numbers 
of lepers are attracted as beggars to that town (Amoy), but this does not explain the extent of its 
prevalence, and in the population of the neighbouring villages one leper is con- 
sidered to exist for every 450 of the population, or thereabouts.' In 
a foot-note Dr. Manson writes : ''We should be rash to conclude that a haderium, described by 
Hansen, Bklund and Neisser [London Mcdlcdl Record, July 15th, 1880), had anything to do with 
the causation of leprosy. The present is the age of bacteria, and as they are searched for every- 
where, and in nearly every disease, they are found everywhere and in every disease. Concomi- 
tance and consequence are easily mixed up. Such a degenerate and half-dead piece of flesh as 
is a leper-tubercle is just the place wherein one would expect to find bacteria. Though one 
expects to find maggots in a dead body, yet we do not attribute the existence of the body, or its 
death, to the maggots ; neither, when we find bacteria in the tubercles of a leper, should we, 
without other evidence than mere concomitance, attribute the tubercle and the leprosy to the 
bacterium. This bacillus Icpnc may, and probably will, turn out a mare's nest, like so many of its 
predecessors.' — (XXI. 27.) 

Some consider that the disease called ' morphtea ' is a phase of leprosy ; but although Dr. 
Manson has for many years been on the look-out for morphtea, he has not met with a genuine 
example of the disease. Pale, circular, waxy-looking patches, devoid of hair and 
° ^ ' sweat-glands, with a vascular border and slightly depressed and an;esthetic centre, 
he has often met, but always in connection with other evidence of leprosy. Scleroderma is con- 
sidered to be allied to morphwa. On the supposition that the latter is a form of leprosy, sclero- 
derma should be common also at Amoy, whereas he has only seen one case of it. — (XXI. 29.) 

At Taiwan-foo, in the Eeport to September, 1871, it is stated that no cases of leprosy pre- 
sented themselves for treatment, although it is well known that the disease is by no 
means uncommon in the district. — (II. G8.) 



LEPU'OSY. 153 

At Canton, 1871, leprosy, both anaesthetic and tubercular, is common among the natives; no 
European, however, has ever been known to be affected with it. The statement that the disease 
cannot be conveyed by sexual congress ought to be received with great caution. 
As to treatment, nothing very satisfactory has been recorded. It is stated that 
leprosy was known to occur in the person of a European 14 years resident at Hong Kong. — 
(II. 71.) See Erasmus Wilson, 'Diseases of the Skin,' sixth ed., p. 633. 

Dr. Wong furnished a note on leprosy in the Report to September, 1873, from which the 
following particulars are taken. The disease is very common in the Canton proviuce ; it is 
endemic there, and prevails equally among the population on shore, and that of the boats. Outside 
Canton there are two leper villages ; among the residents of them are many persons who are 
descended from leper parents, but who themselves have ' little or no trace of the disease in them.' 
Of the whole empire, leprosy is most prevalent in the provinces of Canton and Puhkien. It is but 
little seen in Kwang-si, and in the north of China. In the province of Canton it is most prevalent 
in and around the city of Canton, in the districts of San-ni, San-ning, Shan-tak, Hiang-san, 
and Tung-kun ; also in the districts south of Canton, and on the island of Hainan. According 
to Chinese opinion, leprosy is capable of spontaneous production in malarious localities ; heat 
and moisture are allowed to be powerful causes, and as an argument against the necessary con- 
nection between malaria and leprosy, it is observed that in America there are many swampy 
places in which leprosy is absent, and that at Shanghai malai-ial fevers are frequent, but leprosy less 
so. At Canton, many of the lepers state that they had not been subject to frequent attacks of ague 
prior to their leprosy. Neither does the latter prevail especially among such persons as are under- 
fed. All the lands around Canton have been under cultivation from time immemorial; the fields 
chiefly covered with rice, and there are no neglected marshes. In Kwang-si, the rice-fields are 
less under water than at Canton, and in the former leprosy is less prevalent than in the latter. 
It does not appear that fish-eating plays any part in the causation of the disease. The rice used 
by the population is generally good ; such as is bad is given to pigs, or ' used for other purposes.' 
The people of Canton generally live well ; they are well clothed, and usually are well off as re- 
gards money ; and yet lepers abound. In those cases where the disease arises de novo, the mode 
of living and the food of individuals attacked will be found to differ in no respect from that of 
other people. Europeans living in warm climates appear to be comparatively exempt from the 
disease. Among the natives, leprosy consists of no more than two principal varieties; the 
tubercular, which forms three-fourths of the whole number, and the anesthetic. The Chinese be- 
lieve that a woman may have her system so impregnated with the poison as to be capable of 
infecting healthy men, without any external marks on herself except some unusual paleness of 
face. 

A closely allied form of disease is a red tinea-like erythematous eruption occurring in 
patches called Hung-yiln-hiueli-sien — blood-coloured ringworms. If curable, they go by that 
name ; if incurable, they are called leprosy. Morpheea and white patches more or less an- 
esthetic are regarded as varieties of the disease. 

It is stated that leprosy is on the increase compared with what it was ten years ago. The 
disease is found in all classes of persons, rich and poor, in the city and in the country, among 
nitisans, tradesmen, and field labourers. Only one European resident at all the Treaty ports in 
Gbina has been heard of as being affected with the disease. He was an old resident in the 
Canton district; a man of dirty habits, and much in contact with the natives. He had in his 
house a native assistant attacked with leprosy. During five years master and assistant lived 
much together, and the former then became attacked with the disease in the feet, the Chinese 

20 



154 EPITOME OF MEDICAL BEPORTS. 

attributing his attack to infection. The wife of another native assistant living in the same house 
was also attacked with leprosy. It is stated that among the natives generally the proportion of 
cases due to spontaneous origin as compared to those in which the disease is propagated is about 
30 to 40 per cent. Lepers do not intermarry with the healthy, but leprosy sometimes breaks 
out in people after marriage. Nearly all the children of lepers show the disease. As a rule the 
disease becomes milder in each succeeding generation ; in the third, the descendants can only be 
distinguished from ordinary people by a greater pallor of face. In the fourth, it is considered 
safe to marry, although this is not generally done. So long as marriage is confined to lepers 
there is a tendency to a natural extinction of the disease. As to heredity, family taint favours 
the development of the disease, but the extent to which it does so cannot be estimated with 
accuracy. There is one family in Macao in which every generation produces one lejoer, and the 
Chinese, observing similar facts in other families, attribute them to Ftmg-shui — the influence 
exerted on the family by the ancestral grave (heredity ?). The Chinese have a firm belief in the ex- 
tension of leprosy by means of cohabitation, yet husbands and wives, one or other infected, may 
live together for years without infecting the other; but the natives believe that wives of lepers, 
even when showing no marks of the disease, are capable of infecting healthy people through co- 
habitation. Another belief is that persons infected with a mild form of the disease can get rid of 
it by cohabitation. This is what they call ' selling off leprosy/ and many instances are believed in 
of the disease being thus contracted by a healthy man from the wife of a leper who has clan- 
destinely adopted this supposed method of freeing herself from it. Cases illustrative of com- 
munication of the disease in this way are given. The reporter states that he has seen many 
cases of leprosy benefited by the long-continued use of mixtures of arsenic, or Donovan's solu- 
tion ; the particular kind so benefited being a mild species of the anassthetic variety — reddish 
patches of irregular shape, with slightly elevated margins, and sensibility impaired in the part 
affected.— (VI. 41, 51.) 

At Hoihow, during the six months ending the olst March, 1881, a large amount of leprosy 
was reported as existing in the neighbourhood^ The lepers are frequently to be seen along the 
sides of the principal streets exhibiting their sores and soliciting charity. Their 
own huts are clustered together, and they form a small village. Dr. Aldridge has 
not seen a single infectious case of the disease. An instance is recorded there of a young mother, 
observing symptoms of leprosy in herself, committing suicide by means of opium. Her relatives 
allowed her child to die of neglect. — (XXI. 74.) 

No case of leprosy in Europeans or Americans has been observed in which the disease 
Japan. originated in Japan. — (XV. 57.) 



XXI. ELEPHANTIASIS. 

At Kiukiang, 1871, a case of elephantiasis of the right leg and foot was reported. The part 
affected was converted into a browny mass, but pitting on pressure ; the skin of the heel and 

KiukiaE dorsum of the foot roughly papillated. There was no pain, but, on the contrary, 

lu laEg. ^gggig^t sensibility and a want of mobility. Arsenic internally, with bandagino-' 

and mercurial dressing, effected a marked diminution in the volume of the limb within a month. 

—(II. 66.) According to the Report on that place to March, 1882, elephantiasis is seldom seen there. 



ELEPHANTIASIS. 155 

althougli common at the coast ports. In the period under notice only two cases of the disease 
presented themselves, and in these the patients did so on account of some more pressing ailment. 
-(X.l.) 

At Ichang, in 1880, the absence of elephantiasis, and of epidemic disease, and the scarcity 
of morbid growths, was noticed. — (XX. 20.) Ichang. 

At Hankow, in the six months to September, 1872, there were recorded eighty cases of 
' Elephantiasis Grcecorumj' but no further details occur, except that remarks on them 
appear under the heading ' Leprosy.-" — (IV. 72.) 

In the Eeport on Shanghai to September, 1876, the following details occur in reference to a 
case of elephantiasis : The patient, a Chinese woman, a native of a marshy district near Paoshan, 
had never suffered from fever. Bight years previous she was attacked with that . 

disease, which is very common in that neighbourhood ; her right foot was the first 
part affected, afterwards the entire limb. Treatment by warm baths and mercurial inunction was 
at first tried, according to Hebra-'s plan. The limb having steadily continued to enlarge notwith- 
standing these measures, the right external iliac artery was ligatured according to Liston's 
method. Two days afterwards the patient suddenly became cyanosed, and died in less than ten 
minutes, the death most undoubtedly to be attributed to the operation. This case once more 
raises the question whether ligature of the main vessel in elephantiasis is justifiable in itself. 
Fayrer, Simon, and Demarquay pronounce decisively against it. — (XII. 10.) 

At Wenchow, during the six months to March, 1878, cases of elephantiasis were in two 
instances met with. — (XV. 41.) The subject of ' malarial leg,' discussed in the 
Report for the period ending September, 1881, comes more appropriately under the 
heading ' Beri Beri.'— (XXII. 40.) 

At Foochow, during the six months to March, 1881, three cases of old-standing elephantiasis 
of the leg, and four of elephantiasis of the scrotum, were examined without success 
for ' embryo Filarise.'— (XXI. 56.) ^°°*'"'- 

Elephantiasis arabum, or elephantiasis, is often met with in and about Amoy. It occurs most 
frequently in the legs, next in frequency in the scrotum. The medical officer considers the 
pathology of the disease to consist of an affection of the lymphatics, excited by 
' malarial ' influences, resulting in inflammation and constriction of those vessels, 
thus producing the characteristic swelling and other symptoms of the disease. He has never, or 
very seldom, observed enlarged spleen coexisting with this disease, although ague and malarial 
fever usually attend its development j he accordingly thinks that elephantiasis is vicarious of 
enlarged spleen. In some cases the one affection, as the other, occurs in the absence of a distinct 
attack of ague, yet both may depend on malarious cachexia. At Amoy, elephantiasis agrees with 
the description of the disease usually contained in books on the subject. ' It is seldom that we 
meet a Chinaman with sufficient faith in our remedies to induce him to submit to a long course of 
drugging.' The plan adopted by the reporter is to place a blister over the enlarged inguinal 
glands, rub iodine ointment into the swollen leg, apply bandages evenly and firmly, give iodide 
of potassium and quinine internally, and give improved diet. — (III. 24.) 

With regard to ligature of the femoral artery, it is stated that the accounts of this operation 
as a means of treatment in cases of elephantiasis are so contradictory, and the principle on which 
it is based so utterly at variance with our ideas and with the pathology of the disease, that the 
reporter never thought of recommending it. The disease is not looked upon as a true hypertrophy. 
When elephantiasis attacks the scrotum medical treatment is disappointing and only waste of time, 

20—2 



156 EPITOME OF MEDICAL REPORTS. 

and removal should be at once had recourse to. In the Report before us the relative advantages 
and risks of two different methods of operating are discussed, preference being given to that m 
which the testicle and penis are preserved. — (III. 27.) 

In the period ending March, 1874, Dr. Manson performed the operation for elephantiasis of 
the scrotum in 31 cases without a death or serious mishap. He states that there is often a partial 
return of elephantiasis, not in the cicatrix, but in the skin which at the time of operation was 
supposed to be sound; but, as far as he has seen, it seldom amounts to more than a partial 
thickening. In one case there was a serious relapse of the original disease.- — (VII. 28.) 

In his Eeport on Amoy for the half-year ending 31st March, 1877, Dr. Manson continues his 

consideration of filaria. Having lately found filaria in the blood of a patient affected with 

. elephantiasis scroti, he says he 'is thus enabled to state positively that the 

affection is a parasitic disease ■' he considers also that this is the true pathology of 

this puzzling affection. Much remains to be done in working out the details of the operation of 

the cause.— (XIII. 31.) 

In the Report on Yokohama allusion is made to the investigations by Dr. Manson, of Amoy, 
which ' seem to prove that this disease should be relegated to the class of parasitic 
diseases.' In the records before us only one case is reported, and it is in the person 
of a Malay who brought the disease from his own country. — (XV. 68.) 



XXII. LTMPH SCEOTUM. 

In the Report on Amoy to September, 1871, Drs. Milller and Manson draw attention to notes 
of three cases of a peculiar form of scrotal disease, regarding which they can find no description 
in the usual authorities. The scrotum in those cases was thickened and tubercular, 
the skin tough ; when pricked, a clear fluid, rich in albumen, was discharged with 
considerable projection, and through vesicles which occurred on its surface the scrotum could be 
injected. — (II. 13.) In that to March, 1873, details occur of six cases of lymph scrotum. In one, 
when the scrotum first began to swell, the patient had also attacks of quotidian and tertian agues. 
When ague came on, the inguinal glands and scrotum became red, swollen and painful ; but when the 
ague got well the local symptoms disappeared. These continued during ten years prior to his 
admission into hospital. In a second case a similar connection between ague and the local 
affection was observed. In two other cases the same circumstance was noticed. With reference 
to the cases reported, the medical ofS.cer connects the recurrence of lymph scrotum with ague. 
After a time, one of the vesicles which appear on the rough and thickened surface of the part 
bursts, or is pricked and gives exit to 8 or 10 ounces of serous-looking fluid, after which it heals, 
but again to fill after a few days. The fluid is found to be loaded with albumen; it has a 
specific gravity of lO'lO : it contains corpuscles like those of the blood, the spherical in a much 
larger proportion than in that fluid, and those resembling the red corpuscles destitute of colour 
and cohesive properties. The disease is described as being 'a sort of lymph dropsy,' but 
otherwise the medical officer finds it difficult to determine what is its precise nature. Ho 
observes that, ' Why the lymph should not become organized into a tissue, as in elephantiasis, 
when in the body, is a mystery of the disease.' — (V. 9.) 

In 1874 he relates further cases of the disease, in some of which lymph scrotum and 
elephantiasis were combined, and where a chylous state of the urine took the place of the dis- 
charge of lymph from the scrotum after its removal. — (VIII. 67.) 



LYMPH SCROTUM. 157 

Tn his Eeporfc for tlie six montlis to September, 1875, Dr. Manson gives a resume of tlie 
literature in regard to lymph scrotum. He observes that the first description of the disease, so 
named, appeared in 1854, in the ' Transactions of the Medical and Physical Society of Bombay' 
(New Series), vol. ii., p. 341, by Mr. Anderseer Jamsetjee. In January, 1860, a second and third 
case were published in the Edinburgh Medical Journal, by Dr. Wong-Fun of Kumleefou, near 
Canton. Dr. Vandyke Carter published further particulars regarding the affection in the above- 
quoted 'Transactions' of the Bombay Society, 1861 and 1862, and in the ' Medico- Chirurgical 
Transactions of 1862,' vol. xv. In his work on '' Clinical Surgery in India,^ published in 1866, 
Sir Joseph Fayrer describes a case of lymph scrotum under the term ' Nsevoid Elephantiasis.' 
He again alludes to the affection in his ' Clinical and Pathological Observations in India,' in 
1873; also in the Practitioner for August, 1875. The Indian Medical Gazette for August, 1874, 
contains an interesting analysis, by Dr. McLeod, of the literature of this subject ; as also the 
history of a case of the disease observed by himself, and called ' Yarix Lymphaticus.' Dr. Druitfc 
alludes to the disease in the Medical Times and Gazette, and Dr. Lewis in the ' Eeports of the 
Sanitary Commissioner with the Government of India.' Dr. Manson, in his remarks, endeavours, 
if possible, to establish : first, the generic identity of lymph scrotum and the ordinary form of 
elephantiasis ; second, the generic identity of elephantiasis and tropical chyluria ; third, that 
these three diseases acknowledge the same etiological cause ; and lastly, that this cause is the 
FiLAEiA of Lewis. 

Dr. Manson quotes from an article in the Indian Annals of Medical Science, No. TV., April, 
1855, in which Dr. Allan Webb states that a patient, after each attack of fever, from which he 
suffered during a period of four years, found that the scrotum exuded a quantity of wldte ropy- 
looMng matter, which very much reduced its bulk ; that this exudation suddenly ceased, and then 
the tumour of the scrotum rapidly increased in size. During the paroxysm of fever, minute 
vesicles, about the size of a pin's head, appear all over the tumefied scrotum j these look as if 
distended with serum ; after the fever, they break rapidly, and discharge their contents. And in 
a case reported by Dr. Manson himself, '' the scrotum for upwards of ten years discharged 
regularly, once a month, from 10 to 50 ounces of white fluid: this stopped, and the parts then 
enlarged, assuming the usual appearance of elephantiasis.' Among other authors referred to 
in connection with this disease, are Brett, in 'A Practical Essay on some of the Principal Diseases 
of India;' Wise, in 'The Transactions of the Medical and Physical Society of Calcutta,' vol. vii. ; 
Bouilland, Eayer, and Sir James Paget ('Lectures on Surgical Pathology'). He also quotes 
from ' A Treatise on the Grlandular Diseases of Barbadoes,' by Dr. James Hendy, published in 
1784. Dr. Manson expresses an opinion that the generic identity of tropical chyluria and 
elephantiasis is more difficult to establish ; but still, he thinks, sufficient evidence can be brought 
together to warrant such a conclusion. Having adduced arguments with this object, he refers 
the reader to the writings of Roberts, Beale, and Carter ; then adds : ' Seeing then that lymph 
scrotum and elephantiasis are proved to be closely allied, the inference that the latter and 
tropical chyluria are similarly connected may be drawn.' 

In reference to the etiology of these diseases, Dr. Manson takes notice of the views expressed 
by Drs. Roberts, Carter, Beale, and Lewis. He observes that in 1870, Dr. Lewis discovered in the urine 
of an East Indian, a patient in Calcutta, suffering from chyluria, the Filaria sanguinis hominis; and 
that subsequently similar coexistence of the filaria and chyluria was observed. ^ But,' he writes, ' a 
fourth case in which hasmatozoa and chyluria were associated had a fatal termination, the imme- 
diate cause of death being diarrhcea. A post-mortem examination threw no light on the source of 
the filariee. In a second case the results were similarly negative. In 1873, Dr. Lewis examined 



158 EPITOME OF MEDICAL EEPORTS. 

a case in which chyluria was combined with an elephantoid state of the scrotum^ and in which 
the urine also contained a little coagulated blood, filariae being detected in the latter. Bat 
there follows a case of scrotal tumour in which the existence of chyluria was not discovered on 
examination, but in which filariee were found in a chyle-like fluid obtained from an elephantoid 
scrotum. 

Dr. Manson writes : ' Helminthologists know that these filari^ are the young of some mature 
nematode which, though it has hitherto escaped detection, must exist in the body ;' and then he 
refers to experimental researches on the dog in India, performed by Dr. Lewis in reference to 
filariae in that animal. He adds, ' We do not as yet know the seat of the parent parasite,' but he 
supposes it to be on, or in, the lymphatics in a case of lymph scrotum, the receptaculum chyli, 
or thoracic duct, or some blood-vessel. (See also Medical Times cmd Gazette, of 4th June, 1881.) 

Regarding ' elephantoid ' disease, Dr. Manson observes that it has a great preference for 
certain parts, especially the lower extremities and scrotum, and, including chyluria, the urinary 
organs. He also notices the fact of their having a particular distribution geographically j and 
quotes Dr. Hendy, who wrote in 1784, in support of the view that elephantiasis was then imported 
into Barbadoes by means of negroes from Africa. — (X. 1-11.) 

According to the Eeport on Yokohama, parasitic chyluria is occasionally met with among the 
Japanese. Dr. Simmons and Dr. Groertz, of Tokio, have seen cases of the disease, 

Japan. '■ 

and have detected the parasite. The former had under his care a case of the 
disease in a patient who appeared to have contracted it in India. — (XV. 68.) 



XXIII. PHTHISIS. H^KOPTTSIS. 

In the Report on Peking to 31st March, 1875, Dr. Dudgeon gives some particulars regarding 
the Chinese theories of consumption : '' They consider consumption to be infectious, and account 

for it on the hypothesis that at the moment of death of the phthisical patient a worm. 

{Bacillus tuberculi?) is expelled which enters the body through the breath of those in 
attendance. To stamp it out, therefore, the patient, while still alive, was put into a oofiin, burned, or 
thrown into the river; and so, infectious consumption was warded oif from the surviving members of 
the family.' Dr. Dudgeon thinks that '' this may be the Chinese notion of the hereditary character of 
consumption.'' In the same Report he alludes to the frequency and comparative severity of hcemo- 
ptysis among Chinese, and the immunity they seem to enjoy from its effects as compared to what is 
observed in the West. The Chinese will be subject to this disease for years, following some of the 
roughest and most exposed occupations, although ultimately, Dr. Dudgeon supposes, succumbing 
to pulmonary disease, or the rupture of some large vessel. In some instances, at least, hsemoptysis 
appears to be pointed at as a result of ' anger or of sprains.' — '(IX. 22.) 

In the Eeport on Hankow for the six months to September, 1872, the medical ofBcer writes, 
regarding the natives of China, that ' if the disease be rarely met with, it will show that certain 

elements now supposed to be powerful agents in rendering phthisis prevalent 

among a population have been over-estimated as regards their evil influence on the 
body, or that some other conditions exist which modify or neutralize them.' Dr. Buchanan and 
Mr. Simon declare that (in England) dampness of soil is an important cause of phthisis to the 
population living on that soil. Now, around Hankow, in the towns and in the country districts, 
drainage is either unattempted or most ineffectually carried out, and during several months of 



PHTHISIS. HAEMOPTYSIS. 159 

the year the subsoil water is either close to the surface of the ground, or both town and country 
are more or less submerged by the overflow of the rivers. Impure air and want of exercise have 
also been shown to be active causes in the development of phthisis. Not only in man, but in 
animals, confinement and breathing an impure atmosphere have been found to create a tendency 
to phthisis. Among the Chinese, Dr. Porter Smith writes that they spit blood with little or 
no provocation at all ; but he did not think that evil consequences resulted from this, or that 
phthisis was a prevalent disease. In the statistical return attached to the Report now being 
quoted from, however, 118 cases of phthisis are shown as occurring in Chinese patients; so that the 
disease is really of somewhat frequent occurrence among them. — (IV. 75.) 

At Shanghai, in the half-year ending March, 1872, there were five deaths by phthisis, the 
disease in each case dating from a period previous to the arrival of the patient at that place. 
The medical ofiicer had not seen the disease originate there, and he states that such 
an occurrence is very rare. — (III. 80.) In 1872, the medical officer again recorded 
the circumstance that phthisis was always imported, and that its occurrence was distributed 
pretty generally over the six months ending September of that year. Adverting to the question 
of supposed antagonism between phthisis and malarial diseases, he remarks that the disease is 
common among the Chinese inhabiting the neighbourhood of Hankow, and that the circumstance 
disposes of the opinion that there is an antagonism between malarious poisoning and tuberculosis. 
At Shanghai, on the other hand, experience supports the theory of antagonism. — (IV. 100.) 

At FoochoWj from October, 1872, to March, 1873, the reporter states that of ' chronic phthisis' 
(meaning that form of phthisis which is fatal, independently of destruction of lung-tissue) he has 
never seen a case of local origin in a foreigner at this port. He observes that 'the chief 
mortality is due to dysentery and diseases of the liver, while the place is remarkably 
free from zymotic diseases.^ He considers that ' mortality among foreigners in China is much less 
than is generally supposed.^ He adds : ' If it be shown that the foreign death-rate in China does 
not exceed that of our healthiest towns in England and Scotland, it follows that the large extra 
premium charged by nearly all the insurance offices for residence in China is greatly out of 
proportion to the risk.^ — (V. 43, 44, 46.) 

At Amoy, during the half-year to September, 1873, two deaths by phthisis occurred among 
the residents. One came from Kelung in an advanced stage of the disease ; the 
other died at sea from profuse hsemoptysis, on the return voyage from Newchwang, 
whither he had gone for change. — (VI. 20.) 

At Takow and Taiwanfoo, in the year ending 31st March, 1873, there were forty-seven 
cases of phthisis treated. Here both tubercular and malarial disease prevail in 
the same district of country. — (V. 28.) 

At Canton, to September 30th, 1873, phthisis is tolerably common, though not so much so as 
in Europe and America. The reporter considers that neither the south of China nor other part of 
the tropics furnishes a climate favourable to this disease. The people in and around 
Canton who are most commonly affected with consumption are the families of the 
rich. It is more prevalent in the city and among men of business than in the country, and among 
women than among men. The extent to which it prevails is increased by the system of the rich 
natives of getting as concubines fair-haired delicate-looking women ; and by the general manner 
of life of those classes, among whose children scrofula in various forms is very common. It is 
stated that natives of Canton become very liable to phthisis when they proceed to reside in the 
northern parts of the empire. — (VI. 50.) 

Phthisis pulmonalis does not appear to be of frequent occurrence either among foreigners or 



160 EPITOME OF MICDICAL REPORTS. 

Datives of Y okohama ; yet neither class is by any means exempt from it. Indeed, taking the 
mortuary returns from 1871 to 1877, it would appear tliat the relative prevalence 
Japan. ^^ ^^^ disease is somewhat greater than the average for the temperate zone 
generally.— (XV. 57.) 



XXIV. PUKPUEA AND HiEMOPHILA. 

At Hankow, during the year ended September, 1874, a case occurred of an infant convalescing 

from enteritis, being attacked with purpura and rapidly sinking. Death took place 

on the day after the appearance of the patches of ecchymosis, which first appeared 

on the chest. The infant had not been weaned, and seemed well nourished previous to the 

inflammatory attack. — (VIII. 42.) 

In the Report on Shanghai, October, 1874, to March, 1875, the medical officer notices ' & 

curious variety of hsemophila' in the person of a lady, who, during every pregnancy, sufi^ers 

, . from an excessivelv vascular e-rowth springing from the inner surface of the gum 

Shanghai. " '^ loo . 

between the second right upper tricuspid and the first molar, and during each 
confinement vomits alarming quantities (more than two pints) of grumous fluid, consisting of a 
watery secretion from the stomach largely mingled with altered blood. The growth bleeds 
profusely as long as it lasts, but rapidly withers after delivery. 'Astringent washes, and the 
application of dry tannic acid have no effect on it j it checked heemorrhage for a time, but on two 
occasions, at about the sixth month, the entire tumour had to be ligatured. Falling off in two or 
three days, it was after each removal speedily reproduced; the hosmorrhage, however, did not 
become serious before labour, when it stopjoed spontaneously. Under the microscope the growth 
is seen to consist of dense fibrous tissue sparingly vascular, but covered with greatly thickened 
mucous membrane, consisting at first sight of mere meshes of vessels. — (IX. 20.) 

In the Report of Swatow for the half-year ending 31st March, 1877, a case of what appears 
to be hsemophila is recorded. A small anasmic child of eight years of age had for years been 
subject to bleeding from the nose on the slightest provocation. On several occa- 
sions also he passed blood by the bowels. He was treated with the liquid extract 
of ergot and tincture of iron; his diet was made nourishing ; he was restricted from indulging 
in violent play; and in three months the hcemorrhages ceased altogether. — (XIII. 11.) 

In that to March, 1880, a case of haemorrhage from a tooth is related. A strong, healthy- 
looking man, aged 35, suffered from swelling at the angle of the jaw, accompanied with great 
pain and fever, and it was found that he was cutting a wisdom tooth. The gum was accordingly 
freely incised over the coming tooth. Next day some rather fostid matter was discharging, when 
bleeding began from around the tooth. At first it came in small quantities, but by the end of a 
week it persisted freely, and then could be seen oozing from around the tooth, the patient having 
now become faint. Pressure had no effect in stopping the flow, which was of red blood. Per- 
chloride of iron was applied locally and repeated — ergot given internally ; and under these means 
the bleeding ceased. It is noted that the subject of this attack had no hasmorrhagic diathesis, 
and that no reason could be assigned for it. Hsemorrhage after extraction of teeth is a compli- 
cation occasionally met with. See Salter in Holmes' Sijatein of Surgcri/. — (XIX. 12.) 



SCURVY. — ships' hygiene. — ANEMIA. 161 



XXV. SCUEVT. SHIPS HYGIENE. 



At Kiukiaiig, in the year to March^ 1880j a case of scorbutus occurred. The subject of this 
afiection was an Englishman, who, having left his wife in England, neglected himself as regards 
food. Antiscorbutic diet with perchloride of iron and quinine were administered, and 
for a time he improved. Subsequently dimness of sight, headache, drowsiness, 
and then coma occurred, and he died. The patient had been suffering for a period of two 
months from swollen and bleeding gums ; and he stated that he had been living almost exclu- 
sively on tea and toast, abstaining from fresh meat and vegetables. Scorbutus, though usually a 
tractable disease before any of the internal organs have become seriously involved, is undoubtedly 
grave if, in addition, the patient's constitution is debilitated from long residence in the East, as 
in the above case. He is also brooding over other troubles, and, moreover, is advanced in years. — 
(XIX. 9.) 

At Hankow, in the period to September, 1871, the presence of scurvy among the 
crew of a ship is noticed as having led to great mortality among the cases 
of dysentery on board the same vessel, three deaths having occurred in eight 
attacks.— (II. 46.) 

In the Report on Poochow to the same period, the medical officer wrote on the subject of 
provisioning of ships. It has been abundantly proved that lime-juice, however pure, is not by 
any means an infallible protection against scurvy. Merchant captains found by 
experience that their men can be kept in a much better state of general health by . ^ 
supplying them with fresh meat and vegetables two or three times a week, than '^^ ygiene. 
by keeping them upon salt provisions and lime-juice. — (II. 29.) In the half-year to March, 
1873, a case of scurvy on board a German barque was related. The vessel was from Hamburg 
to Foochow direct, 150 days out. There was no lime-juice on board, and no fresh provisions were 
served out during the voyage ; these not being required, as it appears, by German law. Con- 
sidering the length of the voyage and the absence of lime-juice and fresh provisions and veget- 
ables, it is strange that out of a company of fifteen this man was the only one affected. The 
mixture of cabbage and fennel-seed, known as sauerkraut, may have had something to do with 
the immunity enjoyed by the rest. — (Y. 59.) 

In reference to English sailors of the mercantile marine, the Shipping Act of 1867 has done 
much to improve their health and comfort. By the one order to provide lime-juice of good 
quality, it has reduced scurvy by 80 per cent. In 1875, Drs. Muller and Manson wrote to 
the effect that some of the provisions of the Act in question were insufficiently if at all carried 
out. They also urged the necessity, on sanitary grounds, of the crews of ships outward bound 
from England being carefully inspected for disease before leaving port ; also that 
the scale of provisions should be remodelled. — (X. 40.) Similar representations to 
the above were submitted in 1876 in regard to sailors of ships arriving at Shanghai. — (XII. 8.) 

XXVI. ANEMIA. 

In the Report on Amoy, from April to September, 1873, particulars are given regarding 
anaemia from insufficient food. This below-par condition is looked upon as a disease by the 
Chinese ; they call it Ha sian, a term having nearly the same significance as 
anaemia. This condition is frequently observed in persons of the very poorest 
classes, who are insufficiently fed and whose food is bad. In connection with this subject 

21 



162 EPITOME OF MEDICAL REPORTS. 

the reporter observes that the diet of the well-to-do Chinaman is sufficiently nutritious. Rice or 
other farinaceous food, flesh meat, oils, fresh and salted vegetables, supply in abundance all 
the elements for healthy nutrition. But a vast proportion of the labouring classes and pro- 
fessed vegetarians— the latter a very considerable body— live exclusively on rice, fresh and salted 
vegetables, and a small allowance of salt-fish. Numbers of persons, lower in the scale, live 
chiefly on sweet potatoes and salted vegetables, without animal food of any kind ; and there 
are some who are unable to obtain even the latter sort of diet. In consequence of the gene- 
rally prevailing anaemia among the lower orders, there is hardly a case of illness in which 
quinine, iron, and animal food is not required or appropriate. — (VI. 27.) 

XXVII. BEEI-BEEI. 

In his Report on W^nchow, April to September, 1881, Dr. Macgowan gives some particulars 
in regard to the history of beri-beri in China. He finds that that disease is well-known under the 
designation of ' malarial leg,^ Moh-k'i, the same word which the Japanese pronounce 
Jcahhe. Two forma of the malady are recognised, corresponding respectively with 
heri-heri hydrops, and beri-beri afrojMa. There are two kinds, the one caused by moist heat, the 
other by moist cold. ' When the poison rises from the legs to the heart, the mind is affected.' Dr. 
Macgowan has seen one case of the disease. There is reason to believe that the affection prevails in 
Tungking, and a suggestion occurs that it is the disease called ' mauvais vent,'' by Abbe Richard. 
Under the name of Idoh-hoi, or chiaoch'i, this disease seems to have been described in the ' Neiching,' 
the oldest medical treatise extant, a work attributed to Hwangti, B.C. 2697, although it has no claims 
to antiquity, as already observed, beyond the period of the early Chou, or the sources whence 
Confucius compiled his annals. During the Han dynasties ' malarial leg ' was called the ' slow- 
wind disease;' in the Sung sway it obtained its present name. — (XXII. 40.) 

In the Report on Foochow, April to September, 1874, the medical officer wrote that during 
that period he had an opportunity for the first time of seeing two cases of beri-beri. The patients 
were both sailors in a coasting vessel from Singapore, and were natives of the 
Malayan Archipelago. The following information concerning the disease as it 
occurs in the Cocos Islands was obtained from the chief officer of the vessel, who is a native 
of those islands. Beri-beri first appeared in the Cocos about five years ago. There is a small 
island only fifteen miles from the Cocos, called Kuling, in which the disease is unknown, and the 
latter island is therefore used as a sanatorium. People coming from the Cocos generally get cured in 
Kuling. In the Cocos, the natives live mostly on salt-fish — often in a putrid state— and sweet 
potatoes. In Kuling they eat birds and rice. Beri-beri appeared in the Cocos just after the bush 
had been cut down. People subject to the disease have usually two attacks in the year. The 
mortality of its subjects, speaking generally, is about 20 per cent. — (VIII. 62.) 

In Japan, this disease, there known as kaklce, is common and fatal among the natives, but 
very rarely attacks foreign residents. The affection appears to be identical with the beri-beri of 
India and elsewhere. It is considered (by the Reporter) to be due to a specific 
poison, probably allied to malaria. This ' poison ' is considered to primarily affect 
the nervous centres, other exciting causes being held to comprise exposure, bad food, overwork, 
lack of iron in the system, etc. But, according to the reporter, ' no ordinary and generally known 
cause of disease will account for the phenomena of beri-beri.' — (XV. 58.) 

It occurs during the summer months in seaport towns along the eastern and southern coasts 
of Japan. It has two distinct forms ; the wet (heriheria hydrops), and the dry (beriberia atrophia), 



BERI-BERI. 163 

the former in wet seasons, the latter in dry periods, but both in the same locality. For a long 
time its territorial limitation was believed to be the Indian shore of the Bay of Bengal, from 
18° to 20° north latitude, and the Island of Ceylon. It is now known to range through the islands 
of the Indian Archipelago, Java, Sumatra, Borneo, New Guinea^ Banca, CelebeSj Moluccas and 
countries bordering on the Red Sea. As yet there is no certain knowledge of its existence in 
China. No allied disease exists on the European side of the Mediterranean, or in North America. 
Several epidemics of the disease have occurred on board French ships carrying coolies from the 
Coromandel coast to the colonies. In the recent expedition of the Dutch against the Achinese it 
appeared among the troops. In 1866 its occurrence in Brazil was described by Dr. Da Silva Lima. 

In general terms, beri-beri is a disease of low-lying towns on the sea-board, though occasionally 
met with in the interior. Its period of endemic prevalence is the summer months; it often 
becomes severer, or epidemic, in seasons of unusual rainfall. During winter old cases recover, 
and no new ones occur. Old residents are less liable to contract it than newly arrived 
(natives). The best fed, best nourished, and best cared-for, are usually its most frequent subjects ; 
while the weak, destitute, with attendant conditions of bad hygiene, are only exceptionally its subjects. 
It has been looked upon as a result of exposure to marsh exhalations, as a form of scurvy, and as 
rheumatismal oedema. A large proportion of cases occur between the ages of twenty and thirty. 
Comparatively few women suffer from it except during pregnancy, and for a short time after con- 
finement ; its most common form in these is the ' wet.' Those of sedentary habits are most subject 
to it of persons employed on shore ; but it is frequent among sailors, usually appearing shortly 
after their arrival in port and being supplied with fresh vegetables. As a sequence of miasmatic 
and continued fevers, and of syphilis, it is not uncommon. Although frequent in gaols in India, it 
is not so in Japan, unless the prisons are within the limits of its prevalence. It is said that those 
who are best able to afford good food are most liable to the disease. An attack once occurring, 
relapses are very frequent. Foreigners, or natives of America or Europe, in Japan, are almost 
exempt from the disease ; in India, however, they are said to be subject to it. The disease is said 
to attack the occupants of stone-built houses more frequently than those of houses consisting of more 
flimsy materials. It is endemic or epidemic ; it is for the most part limited to well-defined localities. 

At Yokohama an outbreak of the disease occurred on the exposure of new ground as building 
sites, the circumstance indicating its relation to malaria. In the treatment of beri-beri, however, 
the uselessness of quinine was remarked. 

The remedial measure to be adopted is removal of the affected to the mountains. With precon- 
ceived notions of the ansemic nature of the disease, foreign medical men wasted precious time in 
giving their first cases iron and the routine treatment for anaemia ; while the Japanese doctors 
(rude empiricists) saved most of their cases by the opposite plan of rapid depletion and the use 
of hydragogue cathartics. A case is recorded where beri-beri and typhoid fever were combined in 
one patient, yet where recovery from the fever took place. This combination is said to be not 
uncommon. It is in different cases also combined with diarrhoea, dysentery, and marsh fevers. 
In the treatment of beri-beri, rice as diet is to be avoided. This cereal is by some writers charged 
with being the cause of the disease. The almost specific virtue claimed for Treah Farook by 
Indian physicians is considered to be on account of its cathartic properties. Diuretics are indicated 
for the same reason as cathartics. — (XIX. 38 to 76.) See further remarks on beri-beri, also a 
memorandum on Treak Farook, both in the Appendix. 

21—2 



164 EPITOME OF MEDICAL REPORTS. 



XXVIII. DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 

In the Report on Shanghai, April to September^ 1872, details of a case of cerebral abscess 
are given. In connection v^ith that case the medical officer quoted from. Niemeyer : ' Inasmuch 
as encapsuled abscesses (in the brain) presumably do not seriously interfere with the 
intercranial circulation, it is clearly intelligible that they should sometimes be found 
post-mortem, although during life thei'e may not have been even a suspicion of brain disease. 
Moreover, these cases of cerebral abscess which, except for the hurtful influence exerted on the 
entire nutrition of the brain, progress without symptoms, are thus rendered comprehensible. It 
happens by no means seldom that a patient suffers from dull headache, increasing apathy, 
diminution of the power of thought reaching imbecility, blunting of the senses, increasing weakness 
and uncertainty of motion, which certainly place the existence of serious brain- mischief beyond 
doubt, but give no diagnosis of cerebral abscess. Errors, which unluckily are far seldomer 
published than are brilliantly confirmed diagnoses, can arouse surprise only among the ignorant, 
and among those who are imperfectly acquainted with the physiology and pathology of the brain 
and with the diagnosis of cerebral disease.' — (IV. 98.) 

According to the Report to March, 1873, the amount of brain disease encountered at the 
above-named settlement has lately assumed formidable proportions, and threatens to rival in im- 
portance the diseases of the circulatory system to which public attention has been of late attracted. 
—(V. 53.) 

The several forms of affections included under this head are of somewhat frequent occurrence 

in Japan. Oases of cerebral disease and insanity are also frequent, a considerable 

part of the latter more or less directly due to alcoholism. — (XV. 58.) 

Nervous Affection of Tea-tasters. — Certain affections of the nervous system, which are ap- 

Tea-tasters' parently due to the occupation of tasting tea, amount in some instances to grave 

Disease. disorder of the cerebral functions. The reporter rather draws attention to the 

circumstance than enters into details regarding it. — (XV. 59.) 

XXIS. ' THE PEESSUEE.' 

At Swatow, April to September, 1877, diving operations were being carried on at a depth of 
144 feet. The pressure of the water at the bottom was 62-5 pounds the square inch ; the pressure 
of the air pumped down, 75 pounds on the corresponding space. The men employed 
under such circumstances suffered from a peculiar paralytic affection called by 
themselves ' the pressure.' The author alludes to an account of a similar affection as occurring 
among workmen employed on the foundations of the Sb. Louis (Missouri) Bridge. Of 160 men 
so employed, 30 were seriously affected, and 12 died. (See an article in the Popular Science 
Monthly, for July, 1877, on 'Atmospheric Pressure and Life.') Of four men employed in diving 
at Swatow, three became attacked with ' the pressure.' The first symptoms were jerking of the 
lower limbs, and inability to walk when they made the attempt to do so ; loss of sensation in the 
feet and legs ; great pain in the lower part of the spine ; complete loss of power over the rectum 
and bladder. Individual delicacy of constitution is said to have nothing to do with the attack, 
and foreigners are liable to the affection. The first case of it that came under notice occurred 
in a very powerful Cornishman, who ' had been engaged all his life in diving and wrecking 
ventures, but had never suffered in any way from his occupation.' — (XIV. 72.) 



'FOX DISEASE.' — TETANUS, 165 



XXX. ' VOX DISEASE.' 

^ The Chinese hold that reynard is not ' canny,' that he can transform himself and bring about 
evil and misfortune to anyone who injures him, and they therefore stand in great awe of him. 
Dr.^ Dudgeon, in his Report on Peking, to March, 1875, states that he had a ^^^^^ 
patient labouring under ' fox disease.' While squatting, he saw a fox pass him ; ' '°^' 

and from that moment he took ill— had pains all over his body, his limbs shook, his appetite, 
sleep, and usual buoyant spirits left him, he had visions, and great fear got hold of him ; 
his brain was unsteady, and he felt that all he did was in imitation of the animal. The 
result is not recorded. The Chinese entertain many peculiar notions relating to the fox.— 
{IX. 26.) 



XXXI. TETANUS. 

In the Report on Chefoo for the year 1873, a case of traumatic tetanus is recorded. The 
subject of attack had sustained a compound comminuted fracture of the lower third of the leg 
while at sea. After an interval of a fortnight the limb was amputated below the „ , 
knee j a few hours afterwards, tetanus set in, and the patient soon died. — (VII. 20.) 

In reference to a case of traumatic tetanus treated at Shanghai during the summer of 1874, 
the medical officer quotes from opposing authorities regarding the temperature in that disease. 
Wanderlich records it as reachiner 109'4° Pahr., and even 112° Pahr., while 
Uulroth has seen cases prove rapidly fatal without the temperature becoming 
elevated j in others, the extreme rise was to 104° Pahr. In this case the patient had been leading 
a pony by a coil of rope, which somehow noosed him by the chest ; the pony having run away, 
he was dragged for some hundreds of yards, and the skin of the abdomen extensively destroyed. 
On the eleventh day after the injury, he complained of dysphagia; fifteen hours afterwards the 
jaws were firmly clenched, the abdominal recti in a state of tonic spasm, and occasional twitchings 
in the legs. Calabar bean was administered, but from the circumstance of no beneficial effect 
following its use^ the drug was considered to have become deteriorated by climate. — (VIII. 21.) 

At PoochoWj in the half-year to September, 1871, a case of idiopathic tetanus occurred. In 
it, rigid trismus was maintained for twenty-nine days ; opisthotonos and spasms of the laryngeal 
muscles throughout that time, and latterly bronchitis as a complication. The patient 
recovered under the most careful nursing. Large quantities of stimulants and 
strong liquid food were given. Drugs were of little use except to relieve symptoms. Hydrate of 
chloral answered at first in relieving spasm and procuring rest, but had to be discontinued when 
debility set in. Calabar bean was also tried, but had to be given up from its tendency to produce 
nausea. Vomiting would have caused a fatal result from the rigid closure of the jaws and great 
debility present. Morphia then did well. — (II. 27.) 

In April, 1872, a Manila sailor having a fortnight previously injured his hand severely on the 
occasion of being wrecked, was attacked with tetanus, at first of the masseters, platysmte, and 
sterno-mastoids ; ultimately opisthotonos and considerable dysphagia ; then emprosthotonos. The 
patient was treated with chloral in doses of 30 grains every three hours; during his illness he 
taking in all 4 ounces of the drug ; brandy was also given, and the local injury treated with 
belladonna. Recovery took place. — (IV. 61.) 

In reference to the above remarksj Dr. Somerville quotes from various authorities on the 



166 EPITOME OF MEDICAL REPORTS. 

subject of tetanus. Curling's treatise contains 46 traumatic cases occurring in tropical countries. 
Of this numberj 10 — or rather more than 1 in 5 — recovered. Fayrer (Medico-Chirurgical Eeview, 
1868) reports 3 traumatic cases, all of which recovered. The treatment was varied, and included 
opium-smoking. Dr. Shrimp states in the Lancet that the Chinese smoke crude opium in tetanus, 
regarding which Dr. Somerville asks, ' Has anyone in China heard of this ?' In the Half-yearly 
Abstract of the Medical Sciences, vol. Iv. p. 199, Sir Joseph Fayrer has 3 more recent cases, 2 of 
which recovered. Dr. Bakewell reports from Trinidad {Lancet, February 2nd, 1869) a successful 
case, supposed to be traumatic, in a negress. Mr. Croft reports in the Lancet of November 4th, 
1871, 2 cases in St. Thomas's Hospital, in both of which recovery took place. From the resuni6 
given Dr. Somerville concludes, he thinks fairly, that the mortality in traumatic cases is 
considerably reduced since the introduction of chloral. He observes that in this disease 
success is claimed for the most opposite modes of treatment ; and the drugs used are often 
so complex that it is impossible to tell to which, if to any of them, recovery is due. — 
(IV. 61, 62.) 

At Takow, in the six months to March, 1872, among the accidents recorded was that of a man 

whose hand got crushed in a sugar-mill three weeks before admission into hospital. The hand, when 

, seen, was in a most filthy condition. The jaws were firmly clenched. Amputation was 

performed in the middle of the forearm. Opisthotonos and spasm of the inter. 

costal muscles coming on, the patient died 14 days after the operation. Hydrate of chloral was 

given in large doses. — (III. 36.) 

At Swatow, in December, 1876, a Malay sailor arrived frost-bitten from Chefoo. His left 
foot was gangrenous, a line of demarcation formed two inches above the ankle; the foot was 
accordingly amputated on 10th January, 1877. On the 20th, symptoms of tetanus 
showed themselves. On the 24th, the spasms were general ; there was not well- 
marked opisthotonos, yet he suffered severely from dorsal pain. Chloral seemed to lessen the 
severity of the spasms for a time after each dose, but they increased again as another 
dose was becoming due. The patient continued in this state till January 31st, when he died. — 
(XIII. 10.) 

XXSII. BABIES. 

In the Eeport on Peking to September, 1871, the statement occurs that rabies is extremely 
rare. Dr. Dudgeon had not met with a case of that disease in eight years, and had only heard of 

Peking °'^®' ^^^gs are never muzzled, but every householder owns one or two ; so as 
regards these animals, Peking is not behind Constantinople, — (XI. 75.) The 
Pekingese consider it an infallible remedy to swallow the body of a Spanish fly in a 
case of rabies, and the Chinese assert that they have known of cases ' cured' by this means. In 
the urine voided after this treatment has been employed, small coagula of blood occur ; these 
coagula are supposed by some to be the ' poison ' of the rabid animal, by others to be ' small dogs 
formed in the system by the poison.' — (VI. 12). 

At Hankow, during the six months ending March 31st, a case of hydrophobia occurred in 
the person of an adult foreign resident. On December 15th he was bitten by a stray dog. After 

Hankow. *^'° ^^^^ ^^^ wound was cauterized with nitrate of silver; it then healed favourably. 
On February 1st the patient complained of great lassitude and nausea, but without 



BABIES. 167 

pyrexia. In the afternoon of the 2nd, he was unable to swallow cold water ; at the same time 
there was increased secretion of saliva, and the cicatrix of the wound had become red, but there 
was no pain felt in it or in the nerves of the arm. The secretion of tenacious saliva rapidly 
increased, violent delirium gave place to exhaustiouj and on the afternoon of the 3rd he died. 
The treatment consisted of subcutaneous injections of morphia, enemata of cold water and of 
chloral ; but none gave relief. The temperature of the skin, as long as observations could be 
taken, did not exceed 99° Fahr. Post-mortem examination displayed intense congestion of the 
lungs and abdominal viscera ; heart contracted : head and spinal cord not examined. The 
native dog that inflicted the wound was at the time captured by the patient, who kept it in his 
bedroom along with two other dogs, a monkey, and a cat. The dogs, the monkey, and the cat all 
died with nervous symptoms within a fortnight of the bite ; and the two dogs, which had likewise 
been kept in the same room with it, exhibited symptoms of excitement and were destroyed. 
The reporter states that rabies is known not to depend on the ill-usage to which dogs may 
be subjected ; otherwise it would be ever present among the half-starved mangy curs which fight 
for garbage in the lanes of the city. — (Y. 31.) 

In the same Report the medical officer gives some particulars with regard to the treatment, by 
Chinese physicians, of hydrophobia. In the ' E-tsung-king-keen' it is stated that 'the dog 
inhales poisonous emanations, and these, penetrating to the five viscera, produce 
rabies. The main who has been bitten has three chances of dying to one of living.-* '^'""^m?''^"''' 

Treatment. — Immediately after having been bitten, scratch the wound freely 
with a knife till it bleeds plenteously, likewise suck and wash it. Then take an empty walnut-shell, 
fill it with human faeces, lay this on the place bitten, cover it over with moxa made of artemesia. 
Ignite and renew the moxa a hundred times if necessary, until the walnut-shell has been burnt 
black, and the contents thoroughly dried ; then remove it, and cover the wound with the 
Yuh-tsin-san, mixed with saliva. Repeat the whole of this local treatment during the second, 
fourth, and fifth days. Internally, give the Foo-wei-san until heematuria is produced along 
with pain in micturition ; whereapon administer the Soo-peh-pieh-yuh-san, which will alle- 
viate the latter symptom. On the top of the head there will be found a red hair, which is to be 
extracted. 

Second Method. — Take the curd of the black pea, dried and pulverized ; mix it with hemp oil, 
and pour it into a large ball } roll this over the wound for some time, then break it open, and 
inside it will present a hair-like appearance. Continue the rolling until it is found to have lost 
the hair-Hke aspect. The patient must, for the future, avoid eating dog's flesh or silkworms, 
and he must not drink wine or inhale the fragrance from hemp for 100 days. Neither can he 
eat with safety diseased meat or anything in a state of decomposition ; and he must sleep apart 
from his wife for 100 days. He must daily partake of plum-kernels. When the poison of the 
dog has entered the heart of the victim, and has produced feelings of misery and wretchedness, 
the belly swells up, and there is an abundant secretion of saliva ; it is then proper to try the effect 
of "the skull, teeth and toes of the tiger ground up, and given in -g- ounce doses in wine. If a 
speedy cure does not follow, the person becomes mad, barks like a dog, the eyes are white and 
glaring, and death soon ensues. 

Third Method. — Take a wine-cup and fill it with wine ; boil the contents in the cup, and pour 
them out. While the cup is hot press it over the wound, and as it cools it will draw out the 
impure blood. Repeat this operation until black blood ceases to flow. 



168 EPITOME OP MEDICAL REPOKTS. 

The Yuh-tsin-san above mentioned consists of the following^ namely : 

Orris root, -^ ounce. 
Arum pentaphyllum, -^ ounce. 
Peh-fuh-tze, (Aroidese), xV ounce. 
Urtica tuberosa, ^ ounce. 
Angelica, -^-^ ounce. 
Libanotis, ^V ounce. 
Grind into a powder, and moisten. 

Foo-wei-san : Take of — 

Cantbarides, 1 fly. 

A yellow soft earth, 1 ounce. 

Eealgar, ^-^ ounce. 

Musk, -^ ounce. 

Take yV ounce dissolved in a cup of wine for a dose. Repeat the dose three times a day. 
Add one Spanish fly for every day that has transpired since the bite, up to the seventh day ; but 
on the tenth day and afterwards, add ten flies to the mixture. 

Hoo-joeh-pieh-yuh-san : Take of — 

Yellow earth, 6 ounces. 
Liquorice, 1 ounce, 
Amber, ^ ounce. 
Indigo, ^ ounce. 

Mix, and pulverize. Take ^ ounce dissolved in water in which the lamp-rush has been boiled. 

In the 'Wai-ko-ta-tsin' it is stated that rabies arises from a poisonous emanation, which, when 
it enters the heart, makes the tongue hang out ; when it penetrates the bowels, renders the eyes 
dull ; when it goes to the spleen, induces an abundant secretion of saliva ; and when it affects the 
lungs, renders the animal incapable of barking. If it be determined to the kidneys, the animal 
forcibly drags its tail between the legs. 

Treatment. — Immediately after the receipt of the bite, take the Kew-sin-san, which will expel 
the poison through the urinary organs, and for 100 days the patient must not smoke hemp nor eat 
curd made from the red bean. If the cure be slow, and the poison not readily expelled, the belly 
swells up, the voice becomes like the bark of a dog, and the eyes brilliantly white. Under these 
latter circumstances a fatal result is likely to ensue. While taking the above-mentioned remedy 
internally, use the Ghuy-fung-yuh-sin-san mixed with wine, as a local application ; cover it over 
with oiled paper and a bandage — change three times a day. Look for a red hair on the top of 
the head, and extract it. 

Kew-sin-san contains : 

Cantharides without head, legs, or wings, 7. 
Carbonate of lead, ^^ ounce. 

If followed by pain in micturition, drink plenty of the infusion of liquorice root. 



RABIES. 169 



Chuy-fung-yuh-sin-san contains ; 



Heteropa asaroides, 1 ounce. 
Libanotis, 1 ounce. 
Aconitum sinense, 1 ounce. 
Peppermint, 1 ounce. 
Aconitum, 1 ounce. 
Levisticum, 1 ounce. 
Orris root, 1 ounce. 
Atractylodes rubra, 1 ounce. 
Realgar, -f ounce. 

Second Method. — Take one handful of rusli pith, and IJ ounce of black peas; infuse in 
boiling water, and drink along with the before-mentioned hew-sin-san. Locally, mix up equal 
parts of pangolin scales, cantharides, and artemisia. Take a piece about the size of a walnut, 
and after covering the wound with a slice of garlic, place the remedy over it, and ignite ; then 
wash the wound, and use the yuh-tsin-san. If a cure is likely to ensue, no matter ought 
to form. 

[Apropos to garlic, the following is from an article on ' Herb Lore ' in the Standard of June 
9th, 1883 : 'Hellebore and garlic cured the bite of a dog; and the latter herb, if boiled with a 
cock, would make an ointment which secured the person using it against the attacks of lions.'] 

Third Method. — If the wound re-opens, take -^ ounce of realgar and -^ ounce of musk; grind 
them up, and drink in wine. After having drunk this draught the patient rests, and must not 
be disturbed till he awakens spontaneously. If the urine is red and bloody, continue the 
medicine. 

Fourth Method. — Take one nux vomica seed, rub it in water till it has dissolved, and drink the 
solution. 

In the ' Se-yuen-luh,' the following prescriptions are recommended: 'Take seven Spanish flies 
without heads, legs, or wings, and mix them with the contents of two eggs in a basin ; place the 
basin in a covered utensil filled with water, and boil till the eggs are cooked ; withdraw the flies, 
and eat the eggs. In the urine will be found red strings of blood, which contain the poison. If 
there should be pain in the belly, repeat the dose. 

Second Method. — Mix cantharides with the best rice, and cook the mixture until the rice 
becomes of a brownish tint ; withdraw the flies, grind up the rice, and eat it along with eggs till 
there appear strings of blood in the urine. 

Third Method. — Wash the bite with water from a clear mountain stream, and drink the 
freshly expressed juice of the ginger-root. Carefully wrap up the wound so as to protect it from 
the wind. 

Fourth Method.— Take of 

Libanotis, 1 ounce. 

Arum pentaphyllum, 1 ounce. 

Moisten with water, and dry. Eepeat the process seven successive times, then grind into a 
powder. Take jV ounce twice a day, which will produce perspiration. 

In the ' Yen-fan-sin-peen,' a recent work, it is stated that there is an aggravation of the 
symptoms every seventh day. If, perchance, three weeks pass by without such aggravation, there 

22 



170 EPITOME OP MEDICA.L REPORTS. 

is every prospect of the disease being curable. The directions for treatment are — first to look 
for and extract a red hair, which will be found on the vertex ; then to wash the wound with cold 
tea in an unexposed situation, cover it with boiled white of egg-, and over this apply the moxa 
four times. The spot from which the red hair has been extracted is to be covered with almond- 
paste, and a cupful of the juice of the shallot is to be drunk every seventh day during 49 days. 
For 100 days the patient must not smoke tobacco or drink vinegar, and for one year he must not 
eat pork or fish, drink wine, or share the marital couch. Throughout life he must eschew dog's 
flesh, silkworms, and red bean curd. The prognosis given is that of three persons bitten by a 
mad dog in one day, only one will recover. Cantharides is not to be prescribed on account of its 
poisonous properties, and producing pain in micturition. 

Second Method. — Drink the juice of a certain plant, which will produce purging and expel the 
poison in the form of streaks of blood. This remedy is useful at any stage of the disorder. The 
plant should be grown in a pot, the leaves fully matured, 8 or 9 inches long and 2 inches 
broad. Further on, it is stated that persons treated with cantharides must be kept quiet for 
] 00 days ; and that if during that time the sufferer hears the sound of a gong, or the report of 
firearms, rabies is certain to ensue, as the dog is frightened by such noises. It is better to adopt 
the hygiene before alluded to, and take the following remedy : 

Tin, filed to dust, i\ ounce. 

Bisulphide of arsenic, broken into pieces, -^ ounce. 

Liquorice-root, ^^ ounce. 

Lamp rush, 1. 

Nux vomica seeds, 10. 

Macerate in river-water. 

Or the Verbena officinalis may be infused with the Scirpus tuberosis, and taken as a ptisan, 
or instead of these the root bark of the barberry in like manner may be used. Tobacco-oil is 
also spoken of as a certain remedy, provided the person bitten does not taste it hot and acrid. 
Frogs are likewise recommended to be eaten during the period of sickness, the wound to be 
covered with the entrails freshly exposed, and the application changed daily. 

In the ' King-neen-leang-fang' it is recommended to cover the wound with the bark of the 
Sopfiora Japonica, to surround this with a deep ring made of flour-paste, to fill up the ring with 
human fseces covered with another slice of the bark, and over all to apply the moxa, repeatino- 
the burning fifteen times, which will be succeeded by free perspiration. And a mixture of half an 
ounce of the bisulphide of arsenic with 100 bruised almonds may be applied to the wound, and 
also taken internally in doses of one-fifth of an ounce ; along with the latter a preparation of 
tiger's bones boiled in wine should be drunk. Another local application recommended is the 
root of the Gercis slliqua mixed with brown sugar, and internally an infusion of the root of the 
plum-tree. 

In the 'Ts'een-kin-yih-fang' it is recommended to burn the wound with the moxa once a day 
for 100 days, and to eat large quantities of almonds. 

In the ' Pen-tsou-kang-sunh' various local remedies are given : for example, balm-leaves 
ground into a powder ; the leaves of the rehmannia, mixed with rice formed into a cake and laid 
over the wound j castor-oil seeds ground and applied, the bite having been first cleansed with an 
infusion of tobacco-leaves; a mixture of pennywort and realgar; the sulphate of iron; equal 



RABIES. 171 

parts of hair and tenrec-quills {Centetes sp. ?) burnt, and the dust used : internally^ cantharides 
with rice, and a species of serpent dried and pulverized, are considered efficacious. 

The reporter observes, that in the above extracts the necessity of immediately destroying 
the poison left by the bite of a rabid dog is carefully inculcated. The method by the moxa is 
effectual, although unnecessary filthy adjuncts are combined with it. In connection with the 
confidence placed in cantharides, he observes that at one time the same drug was credited in 
European practice with certain virtues in the treatment of hydrophobia. (See Steele's ' Thera- 
peutics,' p. 382. Philadelphia, third edition.) In Aitken's ' Science and Practice of Medicine,' 
some of the other drugs used by the Chinese are mentioned as having been unsuccessfully used 
in European medicine; for example, iron, lead, musk, tobacco, and strychnine. — (V. 32, 
et seq.) 

At Shanghai, in the period to March, 1875, a case of hydrophobia was reported. Of several 
wounds inflicted by a stray dog on the hand, all healed in ordinary course except one on the 
third phalange of the middle finger : it suppurated, became very painful, and cica- . 

trization of it was not completed until three weeks after its infliction. As the disease 
advanced, a solution as follows was injected, at first into the right internal saphena vein ; but that 
vessel becoming speedily obstructed, the operation was continued on the left. The solution was 
considered to represent the composition of the serum of the blood : namely, chloride of sodium, 
60 grains ; chloride of potassium, 6 grains ; phosphate of soda, 3 grains ; carbonate of soda, 
20 grains ; alcohol, 60 minims ; distilled water, 20 ounces. The autopsy was performed four 
hours after death. Nothing was observed except that the spinal cord was aneemic, and all the 
muscles gorged with blood. The period of incubation in this case was 41 days. The attack 
began with severe hypogastric pain ; although the lower surface of the tongue was examined, no 
trace was seen of the sublingual vesicles, known as lyssce j no pain had been complained of in the 
cicatrix of any of the wounds. Morphia injections afforded momentary relief ; chloral enemata 
did not produce sleep, but at least induced anaesthesia ; the operation of intravenal injection 
appears to have hastened the fatal event. 

In reference to the general subject of hydrophobia, the most disquieting suggestion that has 
been made is one originally advanced in 1847 by Dr. Wright {British and Foreign Medical 
Review, vol. xxiii.), and resuscitated by Dr. Muscroft {Lancet, vol. ii. of 1874, pp. 513, 864), and 
by various American physicians; this is, that under certain circumstances, or at certain times, 
the saliva of a dog apparently healthy, and subsequently presenting no symptoms of disease, 
may, when applied to a wound, produce rabies in man. Dr. Wright established, as a result of 
fourteen experiments, that, whatever may be the case as between dogs and men, the saliva of a 
healthy dog is capable of producing rabies when injected into the veins of another dog ; and 
Dr. Muscroft details two cases, which establish the proposition with which he starts. Professor 
Maclean {Lancet, vol. ii. of 1874, p. 6.'i4) gives six cases wherein the periods of incubation were 
respectively 42 days, 43 days, 40 days, 35 days, and a maximum of 60 or 64 days in the fifth and 
sixth cases. Dr. Jamieson draws attention to the fact that ' the dread of fluids which is so marked 
a symptom in the rabid human being, is seldom if ever present in the dog ; that animal may show 
a greedy desire for water.' — (IX. 13, 16.) 

In 1877 a case of hydrophobia occurred at Shanghai. The subject of the disease was bitten 
by a stray dog on 25th May. On 30th August symptoms of rabies appeared, and death occurred 
on the 1st of September. — (XIY. 45) See also Memorandum on Certain Drugs in the 
Appendix. 

22—2 



172 EPITOME OP MEDICAL REPORTS. 



XXXIII. DELIRIUM TREMENS. 



At Hankow, in 1871, the patient to whom Dr. Eeid first administered chloral was the only- 
native Chinese he had met with suffering from delirium tremens. That patient was conducted by his 
„ , wife to hospital, secured in a novel manner. A heavy chain was fixed round his waist 

Hankow. c > i i • j! i- i. i 

by a padlock, and to this girdle was attached in front another chain, four leet long, 
which ended in a weight like a small grindstone. So long as no great restlessness was displayed, 
the patient could with an effort lift the weight and change his quarters ; but if he became at all 
obstreperous, he was held down, and additional rings of stone were slipped on the chain until he 
could only gyrate round a fixed point. When he came under notice, he had not slept for a week, 
and had kept his neighbourhood awake by his shouts. Under the use of chloral, given in forty- 
grain doses, twice daily for three days, he slept, only awakening to take food. He became per- 
fectly quiet, and left the hospital a free man. — (II. 48.) 



XXXIV. EARACHE. 



At Foochow, April to September, 1875, otitis is very common during the hot months, among 
the floating population. It usually follows swimming ; sometimes ends in abscess ; at others, a 
Foochow ^^^^ muco-purulent discharge persists. On examining the meatus, nothing is seen 
in the majority of instances except a reddened and swollen appearance of the 
lining membrane. Dr. Somerville has found the best treatment to be the application of leeches 
behind the ear, painting the latter part with the P. B. tincture of aconite undiluted, and 
syringing the ear with a warm weak solution of carbolic acid in glycerine. The affection is often 
very obstinate. — (X. 35.) 

At Amoy, at the commencement of the rainy season in 1871, several cases of acute inflam- 
Amoy mation of the external auditory canal occurred, and from its frequency the affection 

might be described as putting on an epidemic character. It terminates in copious 
discharge, and temporary impairment of hearing. — (II. 11.) 



XXXV. DISEASES OE THE EYES, ETC. 

At Newchwang, during the winter of 1871-72, inflamed eyes and eyelids were unusually 
prevalent, both affections attributed to the cold winds and dust which prevailed during that 
season. The eyelids were generally granular, and in many cases much everted 
(ectropium). Several Europeans were similarly affected. Treatment by the free 
application of sulphate of copper was perfectly successful, and in the estimation of the Chinese, 
marvellous. A number of Europeans suffered from milder attacks of the same affection which 
yielded to the usual treatment. — (III. 16.) 

At Kiukiang, 1871, affections of the eyes were very common ; 457 cases having presented them- 
selves at the dispensary. As an example out of many such : lower eyelids converted into the aspect 
of raw, red mucous membrane from neglected eczema and inflammation persisting 
during a period of ten years. There were many cases of inverted lashes. The 
solvent action of sulphate of soda upon opacities of the cornea in general may be held to be 



DISEASES OP THE EYES, ETC. 173 

proved. AlsOj tlie benefit upon intense ophthalmia of ' touching ' the gums with mercury. The 
perpetual irritation of inverted eyelashes gives rise to a peculiar but easily curable condition of 
the cornea, which becomes vasculo-nebulous and sodden. A large variety of forms of these 
diseases is enumerated, some of the cases of an aggravated nature. — (II. 63.) 

In the year to March, 1881, eye diseases, so common in every part of this empire, here formed 
no exception; and next to skin diseases, they ranked in prevalence. The results of treatment in 
them were very gratifying, however. Many Chinese applied for relief on account of ectropion, 
cataract, and granular lids ; and many have been so improved under treatment as to be able to 
pursue their usual occupations. — (XXI. 48.) 

In the year ended March, 1882, out of a total number of 3,156 Chinese who applied for 
medical aid, 575 were cases of diseases of the eye and lids, 105 being sufferers from corneal 
ulcer in its various forms. Many cases of corneal ulcer began while the patient was suffering, 
or recovering from malarious fever ; indeed, the debility induced by intermittent and remittent fever 
seems to be the starting-point of a large percentage of the cases seen here. Chronic conjunctivitis, 
with the resulting granular lids, and pannus, is also very frequent. Many operations, including 
those for artificial papil, iridectomy, cataract, pterygium, trichiasis, etc., were performed with a 
fair amount of success. — (XXIII. 39.) 

At Amoy, according to the Report to September, 1877, ulceration of the cornea has been met 
with several times in hsematozoa cases, and is the only mischief which Dr. Manson 

. . Amoy. 

had any grounds for attributing to the embryo of filarias in the blood. — 
(XI Y. 8.) 

At Takow and Taiwan-fu, in 1871, diseases of the eyes were very common. One cause of 
their prevalence is found in the showers of fine sand, which are of everyday 
occurrence during the N.E. monsoon. The continued irritation from this sand Taiwan. 
gives rise to chronic inflammation of the eyes and all its evil results. — 
(II. 68.) 

At Canton, according to the Report to September, 1871, ophthalmia is one of the most 
frequent diseases among the Chinese population; although it is not confined to 
any season, it is most frequent in summer. — (II. 70.) 

The Japanese suffer severely from purulent conjunctivitis. This disease among them is 
contagious, and yet foreigners are rarely attacked by it. There appears, however, 
to be a history of a rather severe epidemic as having occurred among foreign 
residents some years ago. — (XV. 59.) 

According to the Report on Wenchow, to September, 1881, Dr. Macgowan, after careful 
investigation during several years, has failed to find evidence of Daltonisvi among the Chinese. 
He states that of the persons thus examined, the irides were generally dark hazel or t, , ■ 
black, these being the colours prevalent among the people. He mentions the 
circumstance lately ascertained, that Nubians are free from the defect, and remarks that in 
China it is only met with among Europeans and Americans. Of 1,000 native Chinese examined, 
the irides were generally dark hazel, the others black. — (XXII. 45.) 

XXSVI. DISEASE OP THE HEART AND ANEURISM. 

In Peking, to 31st March, 1875, disease of the heart and aneurism appear to be of very rare 
occurrence. Dr. Dudgeon had scarcely met with a case of either. He thinks that 
probably the quiet and abstemious habits of the Chinese may account for this. 
—(IX. 22.) 



174 EPITOME OF MEDICAL KEPORTS. 

At Kiukiang, during the period from April to September^ 1872, a case of sudden death by- 
rupture of the auricle, small and accentuated aneurisms of the ascending aorta, and fatty 
degeneration of the heart, was recorded as occurring in a man of 32 years of age. 
With reference to that case. Dr. Shearer remarks to this effect : In Britain, the 
deaths from disease of the heart have numerically increased, such increase wholly confined to males 
over 20 years of age. These diseases are much less frequent in Germany and France than 
they are in England, least of all among Hindoos, Caffres, Mussulmans, and among rice-eating 
people generally. Dr. Shearer observes, also, that among the Chinese this class of diseases is 
extremely rare. Among their causes assigned by Dr. AUbutt are overwork and strain in the 
heart and great bloodvessels in the case of forgemen, bargees, etc. Mr. Myers traces their 
development among soldiers to the system of drilling with accoutrements. Dr. Quain gives 
weight to the overstrained excitement of our times, and quotes from Corvisarfc as to the increase 
of heart affections during the French Revolution. Dr. Shearer observes, however, that amid 
the quiet languor and monotony of the various parts of China, they are alarmingly frequent among 
foreigners during the prime of early manhood. Much may be assigned to ill-regulated gymnastic 
exercises, and also to ' good living.'' — (IV. 50, 54.) 

In the Report on Hankow for the half-year ending 31st March, 1872, are some remarks on 
aneurism which have a general importance. The reporter quotes from several authors on the 
subject. He remarks that out of 120 oases cited in Cooper's ' Surgical Dictionary,' 
in 5 only were the subjects between 25 and 30 years of age. Gardiner states that 
in his cases the youngest patient was over 34 years of age, the large majority over 40. On the 
other hand, in military life the disease is met with at a comparatively early age, due, as is believed, 
to the system of clothing, equipment, and diet. It is also common among forgemen, puddlers, 
and Cornish miners. He refers to the influence assigned to drunken habits, rheumatism and 
syphilis in inducing degeneration of arterial coats, and thus leading to aneurism. The disease 
prevails to a greater extent in some countries than in others. In Germany, aneurism of the 
extremities is rare ; it is more frequent in France and Italy, and most frequent in England. 
Other extracts follow from the work already quoted. — (III. 45.) In the Report to September, 
1874, a case was recorded in which a young man of 32 years of age having died of disease of 
the heart, with atheromatous degeneration in the aorta, the medical officer points to it as illustra- 
tive of the degeneration to which foreigners residing in China are especially liable. — (VIII. 42.) 
In the Report to September, 1876, the case is related of popliteal aneurism in a native Chinese 
successfully treated by ligature of the superficial femoral artery. — (XII. 17.) In that to Sep- 
tember, 1881, the case of aneurism of the ascending aorta in a member of the Customs outdoor 
staff, in which sudden death occurred.' — (XXII. 1.) 

At Shanghai, in the six months to March, 1872, six cases of death by aneurism were recorded, 
and it is stated that several persons known to be suffering from that disease left the settlement 
during that period. The reporter observes that many persons have aneurism 
who are unconscious of being so affected. At Shanghai, he says, the causes to 
which dilatation of the arteries is due, especially when there exists any constitutional tendency 
to degeneration, are present in full force. The sudden and violent change from the compulsory 
inactivity of the summer to the gymnastic exercises and athletic sports to which a large number 
of young men enthusiastically devote themselves at the commencement of autumn freshness, is 
of itself sufficient to overstrain the arterial system. In England the occasional spurts of a boat- 
race are considered to have the same effect. In China, the comparative rarity of the disease 



DISEASES OP THE HEART AND ANEURISM. 175 

among tbe natives is assigned to their simple habits, phlegmatic and unexoifcable natures ; yet 
among them^ arterial degeneration is common. — (III. 80.) 

In his Report to September of that year, Dr. Jamieson wrote : ' Aneurism is so rare among 
the Chinese, that he may mention one abdominal aortic case in the Gutzlaff Hospital, namely, 
in a woman aged 30.'— (IV. 103.) In that to March, 1873, the medical officer writes : 'Of the 
aneurisms, that fatal in October occurred in a man aged 85 ; that in December in a man aged 38 ; 
of the two in January, one was in a man, the other in a woman, both 30 years of age. In the 
same document the medical officer refers to the large number of cases of heart disease and of 
aneurism, which, of late years, have presented themselves in foreigners resident in China. He 
alludes to the connection said to exist between those affections and malaria ; and expresses a 
hope that this phase of the subject may be fully investigated.' — (Y. 53, 57.) 

In the Report to September of that year, he reverts to the same subject thus : ' The 
alarming frequency and fatality of diseases of the circulatory system among foreigners in China 
ought now to have its effect in causing each person to examine his manner of life.' He quotes from 
Dr. Murchison, that, what in many persons is merely a form of senile decay, may, under certain 
conditions, occur at a comparatively early period of life. Andral and Lobstein long ago con- 
nected atheroma of the vessels with ' a particular taint of the fluids closely resembling gout.' — 
(VI. 55.) 

During the half-year ending March, 1874, five of the recorded deaths were due to aneurism. 
All occurred in males ; of the whole, 3 were of the thoracic aorta, 1 was noted as aortic, 
and in 1 the position was not stated. The ages of the patients respectively were 43, 38, 38, 
and 36. That senile decay in its ordinary sense has nothing to do with the prevalence of 
aneurism in Shanghai is clear, yet it would seem as if in a considerable number of foreign 
residents there exists that degeneration of the tissues which is so often associated with 
advanced life. The reporter considers that the prevalence of aneurism is considerably greater 
at Shanghai than at Hong Kong. — (VII. 36.) 

In his Report to March, 1875, the medical officer states his belief that there exists a tendency to 
premature arterial degeneration produced by residence at the former settlement. In a previous 
Report he quoted from Murchison, to prove that arterial degeneration is most frequently found 
among people who neglect or overtax their digestive functions. Violent exertion of an intermittent 
character contributes its share. — (IX. 11.) In that succeeding, namely to September of the 
same year, he discusses the question whether a connection really exists between syphilitic 
taint of the constitution and aneurism, but with the result to leave it unresolved. On the 
subject of training. Dr. Jamieson writes : ' It is certain that any display in athletic skill which 
demands a preliminary overstrain of the heart and great vessels at a time when muscular 
waste is at its highest, as in rapidly reducing weight by assiduous sweating, is bad.' — 
(X. 60, 61.) 

At Foochow, in the half-year to March, 1873, two deaths by disease of the heart in foreigners 
were recorded. On the subject of 'training,' Dr. Somerville quotes the approval by Dr. Parkes 
of the judicious system recommended by ' Stonehenge.' Dr. Somerville writes : 
' It is known that even at home, high training cannot be kept up except for a 
limited period, and he does not think it ought to be attempted in China at all. Anyone, how- 
ever, can easily form for himself a good practical course of exercises according to his own 
tastes ; and whether it be gymnastic exercises, games, or field-sports, is of little moment, 
provided it be well regulated. — (V. 41, 43.) 



176 EPITOME OF MEDIC A.L REPORTS. 

At Amoy, according to the Eeport to September, 1876, aneurism was rare among Chinese 

patients. Dr. Manson in ten years' experience having only met with two or three 

"°^' cases of the disease among them. — (XII. 39.) In that to September, 1881, two 

deaths by aortic aneurism are recorded ; namely, one in a patient arrived from Hankow, the 

second in a sailor. — (XXII. 1.) 

At Swatow, during the half-year ending 30th September, 1871, it is recorded that a 
case of aneurism occurred ; that it was treated by means of large doses of iodide 
of potassium, with the result that consolidation of its contents occurred in 
ten days.— (XL 9.) 

Diseases of the heart appear to be somewhat unfrequent in Japan, a circumstance which is 
considered to accord with the rarity of acute articular rheumatism in that country ; the latter 
affection being considered to be the most prolific source of the former. Aneurism, 
on the other hand, is of frequent occurrence among foreign residents in Yokohama. 
In many cases the disease is only diagnosed on post-mortem examination ; and there is reason to 
believe that liability to the affection increases with length of residence. — (XV. 59, 60.) Accord- 
ing to the Report quoted from, ' In view to recent investigations which have proved that, in 
China, dogs frequently suffer from aneurism, apparently due to the presence of filaria within 
the system, and that men also suffer from several diseases traceable to allied species, it has been 
suggested that the prevalence of aneui-ism in the human subject in the Bast may possibly be due 
to the same parasite.' — (XIII. 31.) 

XXXVII. PULMONIC DISEASES. 

At Chefoo, Dr. Brereton observed, in his Report for the half-year to September, 1879, that, 

considering the nature of that summer, it was matter of surprise that so few cases of bronchial 

affections occurred ; vet that two cases of pneumonia happened — a disease ex- 

Chefoo. . ^ 

tremely rare there, owing no doubt to the dryness of the atmosphere. — (XVIII. 71.) 
In the period to March, 1880, cases of ordinary catarrh, associated in some instances with 
bronchitis, not infrequently occurred ; these were generally traced to exposure to cold. — 
(XIX 31.) 

At Chinkiang, in the year ended March, 1881, an unusual number of lung cases occurred 
during the summer season. Among them were five cases of pneumonia, namely, 
two in adults and three in children. Four cases of acute bronchitis happened in 
children, and of these one was fatal. — (XXI. 98.) 

At Ningpo, during the winter of 1877-78, there were several cases of bronchitis, but only two 
Nin^po. severe, and all have made good recoveries. — (XV. 21.) 

At Foochow, in the period from October, 1880, to March, 1881, coryza and bronchial affec- 
Foochow. tions ranked next in frequency to malarial fevers. — (XXI. 53.) 

Inflammatory Affections of the Lungs and Pleura. — The Reports notice a steady and uni- 
form increase in the prevalence of these affections at Yokohama, from 1871 to 1874; a sudden 
Ja an decrease in the latter year ; and then a more rapid rise up to 1877. These varia- 

tions may, it is assumed, have a connection with meteorological conditions, but 
details on this point are wanting. Duration of residence on the part of foreigners does not appear 
to have any influence on liability to these affections. The general mortality by them, however, 
is less than the average given for the civihzed world. Bronchitis is occasionally epidemic, as 
influenza. — (XV. 61.) 



LAKYNGEAL CATARRH. 17) 



XXXVIII. LAETNGEAL CATARRH. 



At ChefoOj in the period from October, 1874, to September, 1875, laryngeal catarrb among 
cbildren was described as being an ordinary complaint during the autumn and spring months. 
The affection is so common that there is scarcely a child under three years of age 
who is not the subject of it in a greater or less degree. It appears to be excited 
by the extremely dry weather prevailing at the seasons in question. Its invasion is sudden ; 
commencing at night; the child wakes in great alarm, with difficulty of breathing. There is 
pyrexia, high pulse, and rough respiration, accompanied by a crowing noise, hoarse cough, and 
frequent spasms ; the pharynx is more or less inflamed and congested, this state not always prevent- 
ing free deglutition. These symptoms vary in intensity in the respective cases, but the acute 
stage usually subsides within forty-eight hours of the onset of the attack, leaving free bronchial 
secretion for some days afterwards. At first the attack resembles true croup. Ipecacuanha 
emetics, small doses of grey powder, and bromide of potassium give relief or cut short the attack. 
Occasionally the disease, by extending to the ramifications of the bronchige, gives rise to 
bronchorhoea ; thus the attack may be prolonged for several days. At this stage stimulants 
and expectorants are serviceable. — (XI. 6.) 

At Tientsin, in March, 1879, a peculiar catarrhal fever, attended by croupy symptoms, pre- 
vailed. It began on the 8th of the month. After two warm days, cold winds from the north-west 
suddenly came on to blow, and on that morning four children were seized. On 
the 12th, five more were attacked, and on the 22nd and 24th there were eight ^'™iffec?i^„n"''^' 
fresh cases. The characteristic symptoms were great restlessness, severe cough, 
coryza, dyspnoea, and slight bronchitis. The disease ran its course in from seven to ten days ; 
the termination being attended with diarrhoea in some of the cases, and with profuse perspiration 
in others. The affection was looked upon as infectious. Treatment consisted of emetics, 
ipecacuanha, and salines. — (XVII. 34.) 

XXXIX. ASTHMA. 

In the Report on Peking to March, 1875, Dr. Dudgeon wrote : The Chinese do not appear 
to draw any very definite distinctions between asthma and whooping-cough. When asthma becomes 
chronic, and the patient cannot sleep on account of it, the disease is called hsiao 
asthma, i.e. whooping-cough asthma. In this chronic form, the following prescrip- 
tion is recommended, namely : Arsenic, 1 mace ; bean-curd, 1 tael ; pork, 4 taels — divide into 
three portions, roast, and add flour with which to make pills. Bight different kinds or causes of 
asthma are enumerated, namely : cold or wind, phlegm, air, water, chronic debility, injury and 
weakness of the stomach. In hiccough, called by the Chinese kai-ni, irritation of the nose or 
stopping of the breath is prescribed, and Dr. Dudgeon writes regarding these measures : ' We can all 
testify to their value.' In chronic asthma, medicinal fumigation is ordered. The following compound 
is to be smoked, namely : nan-sing (tubers of Arum pentaphyllum), hwan-tung, hiva, o-hwan shih, 
fo'rh ts'ao (gnaphalium ?), realgar, aa. 1 candareen: to be ground; add artemisia and a slice of 
ginger, and inhale the smoke. If there should be no artemisia, yil-hin (rad. amomi) may take 
its place. As Dr. Dudgeon remarks, here is the germ — nay, the very practice of smoking 
stramonium ; also according to some botanical authorities the fo'rh ts'ao is not artemisia but 
stramonium. — (IX. 36.) 



178 EPITOME OF MEDICAL REPORTS. 

In the Report on Kiukiang, to March, 1872, Dr. Shearer gave details regarding several cases 
of asthma. In one, spasmodic and organic asthma was complicated with urticaria 

Kiukiang. ^ . , . 

and intermittent fever ; in a second, asthma occurred in au opium-stnoKer ; m a 
third, the disease was complicated with fully developed emphysema. — (III. 64.) 

In the Report on Ningpo for the year to March, 1877, a record occurs of the case of a man 

who suffered severely from a sort of asthma brought on by inhaling dust from wheat, while 

superintendius; the loading of a vessel. The chief officer of the vessel was 

INingpo. r o D . .^. 

attacked the evening after leaving the port, and for a time was seriously ill. 
—(XIII. 47.) 

XL. LEECH IX THE NOSTEIL. 

In the Report on Amoy to 31st March, 1874, a case is recorded in which a naturalist who 
had for some months been engaged in travelling in Formosa, complained of epistaxis, pain in 
the head, and other anomalous symptoms. Through a speculum, the medical 
officer saw a dark, shining body far up the nose; and just as the speculum was 
being withdrawn, the head of a leech w.is protruded between the blades of the instrument and 
quickly withdrawn. Au artery forceps was introduced into the nostril, and after one or two 
attempts, was fastened on the head of the animal as it was protruded. Allowing the forceps 
thus attached to dangle from the nose while some salt-and-water was injected, the leech after a 
time relaxed its hold and fell into the hands of the astonished naturalist. According to his 
own account, on a trip to Bankimtang, he drank from a pool in which he noticed some leeches 
about half an inch in length, and he afterwards picked two or three such from the roof of his 
mouth. Some six or eight days afterwards he was troubled with bleeding from the right nostril, 
and afterwards with considerable pain on that side of the nose. He had seen something- 
protruding several times. The leech, when extracted, measured an inch and a half in length. 

A short time previously, a gentleman residing in Tamsui was afflicted in a similar manner. 

Every now and then the head of the animal would be protruded from the nostril, and wander 

about after the manner of leeches over the lip and nose. It was very fond of 

Tamsui. , . ^ , , •' 

water, and its owner could generally cause it to protrude by dipping his face in 
a basin of water. At Takow, Formosa, the medical officer has on two occasions seen what must 
have been a leech in the nostril of a monkey. At the time the nature of the illness of the 
monkey was supjDosed to be polypus. Sometimes, when sitting quietly, a long, dark, fleshy 
body would come out of the nostril, but the movements of the monkey always caused the 
protruded object to retreat.— (VII. 27.) 

XLI. CANCRUM ORIS. 

At Kiukiang, in the six months to September, 1872, four cases of cancrum oris were 

recorded. In all, the children affected suffered also from ague and dysentery, and in all the 

„, , . disease was fatal. The results of treatment in this class of cases are not verv 

Kiukiang. •' 

encouraging, even when seen m the early stage. Suppose the disease arrested 
and cicatrization obtained, the deformity would be so frightful, and the inconvenience so great, 
that life would be no boon to the victim. — (IV. 45.) 

In the period to March, 1882, eight cases of the disease occurred, of which number only two 
did well ; these were treated by the free use of chloride of zinc and stimulants with quiuine. 
— (XXIII. 39.) 



DISEASE OF THE TEETH, QUIKSY, PECULIAR AFFECTION OF THE PHAEYJCX. 179 

XLII. DISEASE OF THE TEETH. 

^ At Kiukiang, during the year 1881, there were among the applicants at the public dispensary, 
thirty-three cases of disease of the teeth or gums. It is remarked that decay of the teeth is 
much more uncommon among the Chinese than among the Europeans. The ^^^.^_^ 
simple nature of the diet of the former is credited with being the cause of this. '" '*"^' 
Decay, when it occurs, is peculiar and usually very slow. It is not uncommon to find a tooth 
with a large central decayed cavity, yet with but the smallest external opening, sometimes a 
mere crack, as it were, splitting the tooth down vertically.— (II. 61.) 

XLIII. QUINSY. 

At Newchwang, during the winter of 1880-81, iiwinsy attacked nearly every foreign adult in 
the settlement. The majority of the patients had more than one attack ; in some instances the 
disease was very severe. The largest number of cases, and the most severe, ^, , 
occurred in the first half of the winter. After a considerable fall of snow the 
cases decreased in number and severity. In the treatment, inhalation of steam, gargles of hot 
water and laudanum, the application of solid nitrate of silver, and astringent gargles were the 
means employed. — (XXI. 38.) 

At Shanghai, in the half-year to March, 1877, a case of extremely acute inflammation of the 
soft palate, pillars, and tonsils, with a good deal of laryngeal trouble, occurred. On the third day 
of the disease gangrene appeared imminent. However, leeching and bran-poultices, 
with deep incisions and constant steam inhalations, moderated the disease, and the 
patient made a complete though lingering recovery. — (XIII. 44.) 

At Canton, in January, 1877, there was a great prevalence among the Chinese of Oynanche 
tonsillaris, with tendency to suppuration of the tonsils, the general type of the disease severe. 
The name given to the affection by the Chinese is Nqo-how or Goose-throat. The 

/-ii • 1 • 1 c Canton. 

Chinese employ m the treatment of this malady a gargle prepared from a soft 
stone-like substance called Hwo-tsao, not unlike biliary calculus in appearance. The story 
regarding this substance is that in Siam, when a monkey is wounded, the creature, from its 
natural instinct, picks out the proper medicinal herbs, masticates, and applies them to the wound, 
so that successive layers are in this way laid on so as to form a mass. In process of time, the 
wound heals, and the dried herbs fall off; they are then picked up by the Siamese, found by 
them to possess peculiar virtues, and sent in small quantities to China as a drug. In the half- 
year ended March, 1880, sore throat was epidemic here. It was attended by slight fever, but 
yielded readily to nitrate of silver. — (XIV. 59.) 

In the spring of 1880, ulcerated sore throat was epidemic. It was attended by slight fever, 
and yielded readily to a gargle of nitrate of silver. — (XIX. IG.) 

XLIV. PECULIAR AFFECTION OF THE PHARYNX. 

According to the Report on Newchwang, for the half-year ending March, 1872, in the far 
north of China,, a peculiar form of disease affecting the throat is met with among the natives. 
It prevails during the winter season, and so far has been met with at no other jq-^^j,]^^ ^ 
Treaty port than Newchwang. Its course is somewhat thus : a chill is experienced, 
then a severe fever lasting a few days; discomfort in the upper part of the mouth ; sensation as 

23-2 



180 EPITOME OF MEDICAL EEPORTS. 

if something were cougBed upj in fourth or fifth day of illness the mucous membrane of the 
back of the pharynx seems to have disappeared, so completely has it lost its distinctive character. 
The surface looks as if a dry sponge had been applied and the mucous membrane rubbed off ; 
what remains of it is dry, shining, and looks as if stretched. Then comes a thin white membrane 
■which exudes from the part aft'ected, and is coughed up; the exudation, at first white and thin, 
becomes yellowish and thick. The mucous membrane throughout the mouth and tonsils remains 
healthy, or very slightly affected. Associated with this affection there is great physical debility. 
A distressing feature is the liability of the patient to relapses. The treatment eraployed consisted 
in steaming the throat with hot water with a little carbolic acid, then gargles containing opium, 
permanganate of potass or sulphurous acid, internally. Phosphates, stimulants, and nourishing 
food were given. The affection may or may not be associated with pulmonary disease. — 
(III. 16.) 

In the period from October, 1871, to 31st March, 1872, the peculiar throat affection above 
allnded to was frequently seen, but in a modified form. The milder character of the cases, the 
reporter considers, was due to the comparatively moist character of the winter. — (Y. 47.) 

XLV. DYSPEPSIA. 

According to the Eeport on Peking to Septembei', 1871, the natives of that capital drink 
a small quantity of whisky at each meal. This samsJiu is very coarse, and contains a large 
^ quantity of fusel oil, rendering it impossible to drink much of the spirit at once. 
Immediately after taking it, the face and eyes glow with redness. Nearly all their 
diseases are traced by themselves either to anger or to wine, and dyspepsia is, without doubt, 
frequently caused by the constant use of the latter. An inveterate form of this affection, 
called ye ho, in which all the food is returned, and which ultimately after a few months causes 
the death of the patient, is universally attributed to spirituous indulgence. The oesophagus in 
such cases becomes constricted just below the larynx, and all food — even water — is returned. 
The only treatment which the Chinese have been able to devise for this formidable complaint is 
bread saturated with the blood of decapitated criminals. — (II. 79.) See ante, p. 3. 

In the Eeport on Amoy for the six months ending September, 1873, a jDeculiar form of 
dyspepsia is noticed. In it the affection is recurrent at intervals of a year. In a case 
recorded, it was apparently related to malarial fever, with which the attacks alter- 
nated. Its chief symptoms are anorexia and eructations of a tasteless, watery 
fluid. — (VI. 27.) Another condition described under the same heading presents such symptoms 
as stricture of the oesophagus would give rise to. This form is of very frequent occurrence, 
Having given details of these illustrative cases of the affection. Dr. Morrison observes that out 
of 3 06-j miscellaneous cases, sixteen were instances of this disease. The ordinary causes of 
stricture of the oesophagus were carefully sought for in every instance, but not definitely found. 
— (XII. 37.) See also Cancek ante, p. 149. 

SLVI. DYSENTEKY AND DIAEEHffiA. 

The occurrence of dysentery in China is one of the great dangers to which sailors visiting 
jjorts, and residents in that country are exposed. Among seafaring persons, more especially 
those of scorbutic diathesis, it is generally severe and often fatal ; in foreigners on shore liable 
to hepatic complication, and showing a tendency to become chronic. Dysentery and malarial 



DYSKNTERV AXD DIARRHCKA. 181 

fevers are frequently present in the same individual; both these diseases chiefly prevail during the 
same period of the year, namely, that in which marsh miasms are most abundant ; they are 
considered to be results of seasonal and climatic causes. 

In the treatment of dysentery in China, ipecacuanha in large doses has been administered as 
in Europe. In particular cases, benefit has rapidly followed; in others, the results have been 
less satisfactory ; in fact, the drug has failed to arrest the disease. 

The native remedy which has attained the highest reputation in the treatment of dysentery 
as that disease occurs in China, is the Ailanthus glandulosa — the actual properties of the plant being 
that it is intensely bitter and astringent ; and also that it is powerfully anthelmintic. 
As is natural to assume from its properties,it is chiefly employed in the chronic form '"men/"" " 
of dysentery. In that form it is administered combined with aromatics, including 
mace, levisticum, liquorice, together with other substances as Lonicera chinensis and charcoal of 
Carthamus tindorlus — the combination taken in rice-jvater while fasting — the diet of the patient 
to consist of milk and rice. This regime has been directed with success by physicians of the 
French Legation in Pekin. In several respects it bears analogy to the treatment of chronic 
cases by the rind of the Garcinla mangosteena in the Straits of Malacca, by powdered bael {^gle 
marmelos) in India. 

At Tientsin, during the half-year ending 31st March, 1873, only one case of dysentery was 
recorded. It occurred in the person of an English sailor who had first been 

P Tieutsm. 

attacked with the disease on the west coast of Africa ; and ultimately proved fatal. 

According to the reporter, cases of chronic dysentery and diarrhoea coming to this place do 

well.— (V. 23.) 

In the half-year to September, 1876, twelve cases of dysentery came under treatment, all 
occurring on board vessels in harbour. Ten of them were mild, yielding to ' expectant ' treat- 
ment ; two were malignant, and resisted all treatment, although, in both of them, large doses of 
ipecacuanha were frequently administered, and were well borne by the patient. — (XII. 48.) 

In the Eeport to March, 1879, malarious dysentery prevailed chiefly among persons on board 
vessels. Ague was at the same time of frequent occurrence. In the treatment of dysentery 
ipecacuanha was generally successful; and afterwards, ailantlms, as restraining diarrhoea. Dysen- 
tery, diarrhoea, and ague ceased after the occurrence of the heavy autumnal rains. — (XYII. 34.) 

In the year ended March, 1880, dysenteric and diarrhoea attacks prevailed, together with 
intermittent fevers. — (XIX. 5.) 

At Newchwang, during the summer of 1871, a few cases of diai'rhoea and of dysentery 
occurred. In reference to the latter affection, the remark appears that at this place 

inn / ■ T , . JNewchwaDg. 

it IS usually amenable to treatment by a lew doses of ipecacuanha, soothing 

enemata, simple diet, and slight astringents. The best precautions against attack consist of 

avoidance of exposure, and of indiscretions in food. — (III. 10.) 

In July, 1877, the state of the conservancy at the settlement was extremely defective. A large 
number of native residents suffered from diarrhoea, and at a later period cholera occurred. — (XV. 28.) 

At Chef 00, January to March, 1872, dysentery was treated by means of large doses of 
ipecacuanha. The same method of treatment was also used successfully in cases 
of intestinal haemorrhage due to tubercular ulceration. Dr. Myers ' cannot speak 
in too high terms ' of the effect of ipecacuanha in dysentery. The physician as well as the 
patient is often tempted to regard it as ' perfectly miraculous.' — (III. 39.) 

In the summer of 1876, severe dysentery, considered to be malarial in origin, affected the 
adult European residents. Dr. Carmichael observes that this outbreak, unprecedented in his 



18'2 EPITOME OF MEDICAL REPORTS. 

experience^ occurred immediately after the first rainfallj and while the temperature was at its 
maximum. In autumn, there was a fatal form of the hemorrhagic type of that disease among 
the Chinese; it affected all grades of society^ and therefore could not actually De traced to the 
scarcity of food then prevailing. — (XII. 42, 44.) 

During the summer of 1878, a considerable prevalence of diarrhoea was observed among the 
visitors and shipping. This was assigned to impure water and unwholesome food. The crew of 
one vessel had beef served out to them that was actually decomposed ; but the circumstance is 
to be noted in reference to certain theories of the day, that no case of '' enteric ' or typhoid fever 
has been reported on the occasion. — (XYI. 16.) 

In the six months to September, 1879, diseases of the digestive system comprised one-third 
of all affections treated, and of them one-third were cases of diarrhoea. These occurred chiefly 
among the shipping, and all progressed more or less satisfactorily, except in two, where the 
disease had become chronic. In them the affection ended fatally, and in each the body became 
covered with purpuric spots a few days previous to death. — (XVIII. 72.) 

At Chinkiang, during the year ending 31sfc March, 1881, three cases of acute dysentery 
occurred, and several of diarrhoea. None of either disease was severe in character, and all 
yielded to treatment.— (XXI. 99.) 

At Kiakiang, 1871, dysenteric diarrhoea and dysentery were usually mild and asthenic, but 

occasionally attended by febrile action. In some the attacks were recurrent and attended by much 

prostration, more so among Europeans than natives. Both dysentery and ague 

were considered to arise from malaria; these diseases seize different members of the 

same family exposed to one and the same conditions. 

A case was recorded of sphacelus of large portions of the mucous membrane of the large 
intestine with extensive intestinal htemorrhage. It occurred in a man of sedentary habits, 
originating in congestion of the viscera and portal circulation. Recovery took place in it. 
Dysentery often is present with ague in the same person. — (II. 61.) 

In the period ended March, 1875, two cases of dysentery in foreigners were reported. Both 
the cases were of ordinary severity, and yielded to ipecacuanha. — (IX. 1.) 

In the year to March, 1876, chronic dysentery was common among the native Chinese during 
the autumn months. The usual treatment consisted of ipecacuanha, acetate of lead and opium ; 
'but as patients rarely return to the dispensary, testing the relative efficacy of medicines becomes 
an impossibility.' Pew cases of diarrhoea occurred among adult foreigners, but two obstinate 
cases took place among children, both under two years of age, and undergoing dentition. In 
them the disease set in at the beginning of the hot weather, and proved intractable. One of the 
children was sent to San Francisco; in the other, alum appeared to be of some benefit. — 
(XI. 14.) 

In the year ended March, 1879, diarrhoea a.nd fever prevailed in an unusual degree. 
Dysentery occurred among the foreign residents. In its treatment, ipecacuanha, aft;er repeated 
trials, could not be tolerated by the stomach ; Dover's powder was accordingly substituted, and 
with opiate enemata was successful. — (XVII. 3.) 

In the year ended March, 1880, a case of sub-acute dysentery was treated by rectal injections 
and ipecacuanha and opium. The patient, who had similarly suffered from previous attacks, 
attributed his more speedy recovery on this occasion to the action of the local treatment. 
—(XIX. 9.) (See Practitioner for December, 1879, pp. 418, 449.) 

In the Report to March, 1881, it is stated that dysentery, acute and chronic, was very prevalent 
among the Chinese during the autumn of 1880. In the chronic cases, Dr. Jardine ' was induced to 



DYSENTERY AND IHARRHailA. 183 

try Icoroniuo, from tlie Veronica fcirviflora, wliicli is largely used ia New Zealand as a remedy in 
dysentery and diarrhoea.' Some of the results exceeded his most sanguine expectations ; many 
of those, however, who received the drug, did not return to report themselves. — (XXI. 49.) 

In September, 1881, there were three cases of dysentery, all of which were readily amenable 
to dietetic and other treatment.— (XXIII. 38.) 

At Hankow, 1871, dysentery in cutumu affects natives and Europeans ; thiSj notwithstanding 
the precautions taken with regard to water. While the latter resided in the native city, the 
mortality by dysentery among them amounted to three-fourths of deaths by all 
causes. Sporadic cases occur with the rise of temperature in May ; it rarely 
becomes epidemic until the variable weather in August. The causative influence of low forms of 
fungi being assumed, an explanation occurs of the disease being viewed as contagious in the 
same sense as cholera and enteric fever. Eelative to Indian dysentery, little tendency exists 
towards serious hepatic or splenic complications. Here the disease was especially fatal in the case 
of children attacked during dentition; in them, head symptoms rapidly supervened. Among sea- 
faring persons suffering from scurvy, it was particularly fatal. Dysentery often began with 
diarrhoea, and that either assumed an acute dysenteric form, or lapsed into chronic dysentery. Ipe- 
cacuanha, in large doses, with tincture of opium, total abstinence being observed in the intervals 
between doses, constitutes the more usual treatment. Enemata of tepid water, infusion of ipecacu- 
anha, or small quantities of creosote, rubbed up with glycerine and added to the enemata, were 
also used. — (II. 46.) 

In September, 1875, a case of dysentery was landed from board ship two days before the death 
of the patient. In this case the immediate cause of death was perforation, deep ulceration being 
in its turn referred to an attack of ' Malta fever,' from which he had suffered two years previously 
{Edin. Medical Journal, July, 1876, p. 46). Adverting to the use of ipecacuanha. Dr. Reid 
wrote, ' The grand array of remedies to be introduced by the stomach or rectum in chronic 
dysentery will be in small request if the acute stages be treated by full doses of ipecacuanha.-' — • 
(XII. 16.) In the year ending September, 1878, a few cases of dysentery, with some of other 
malarial diseases, chiefly fever, occurred among the shipping at this port. — (XVI. 23.) In the 
Report for the half-year to March, 1881, 'a few cases, with one death of dysentery and dysenteric 
diarrhoea,' are recorded, together with a good many cases of simple diarrhoea in children. — 
(XXI. 45.) 

At Shanghai, 1871, during the hot half of the year, dysentery was of frequent occurrence, but 
of tractable form. Ipecacuanha is considered to be the sovereign remedy, in doses of five grains 
with morphia, every three hours, when vomiting is not present; in larger doses . 

when it is. Some cases of chronic dysentery yield only to calomel and opium ; and 
the mercurial treatment of the acute form has its followers. Dysentery and periodic fevers 
are considered to be endemic there. — (II. 39.) In the early months of 1872 some cases 
of dysentery, severe in character, occurred among children ; curiously enough, as observed 
by the reporter, preceding by a short interval the discovery of murrain among the horned cattle. 
He adds, ' It is needless to say that milk forms the staple diet of foreign infants in Shanghai ;' 
and he notices the circumstance as beiug, to say the least, ' a coincidence in connection with the 
occurrence of the cattle-plague.' — (III, 80, 85.) 

In the Report for the six months to September, 1874, details are given of a case in which 
severe dysentery appeared to have set in as a direct result of a large dose of purgative pills. In 
the course of the patient's illness, ipecacuanha, with other remedies, was administered freely, but the 
disease proved fatal. In this case death was preceded by epileptiform convulsions^ leading to the 



184 EPITOME OP MEDICAL REPORTS. 

suspicion that the immediate cause of death was cerebral thrombosis. — (VIII. 27.) In the period to 
Marchj 1875, a case of remittent fever occurred, in which intractable dysentery was also present. — 
(IX. 7.) In that to September, 1876, a case of chronic dysentery is related. The disease had 
existed for months, hepatic abscess being also present. In it ' the patient's extraordinary intoler- 
ance of ipecacuanha in large and small doses gave rise to the suspicion of abscess, but no satis- 
factory physical signs could be obtained before death.' — (XII. 5.) In 1881, Dr. Jamieson 
stated that ' Dysentery is certainly less prevalent here relative to population,' than it was a few 
years before that time — a circumstance which ' may probably be ascribed to the gradual rising of 
the settlements above the level of their earlier days,' and to other sanitary improvements effected. 
— (XXI. 84.) 

At Ningpo, in the half-year to March, 1873, diarrhoea and dyspepsia were among the diseases 
that most prevailed. In one case of dysentery noticed, simple doses of ipecacuanha were 
administered every four hours with most satisfactory results. — (V. 25) In the 
year ending March, 1874, seven cases of dysentery occurred among the foreigners 
at that place. Of these, four were on board vessels in the harbour, and these speedily recovered 
under the use of ipecacuanha. In one of those on shore ' ipecacuanha did not have such a bene- 
ficial effect as a combination of Dover's powder and grey powder given every four hours, and an 
injection of starch and laudanum every night. The other two persons attacked were children, 
and although various medicines were tried, everything failed. — (VII. 21-.) In that to March, 
187(3, a few cases of dysentery occurred. The treatment pursued in all was the administration of 
grey powder and Dover's powder in combination, with an occasional dose of castor oil ; in one 
case a nightly enema of tincture of opium and starch. ' As usual,' the prevailing complaints 
were dyspepsia, during the months of June, July, and August. — (XI. 27.) 

In the year to March, 1877, only three cases of dysentery came under notice. Instead of 
using the powder of ipecacuanha. Dr. Mackenzie used the liquid extract, which he found more 
convenient and equally efficacious. — (XIII. 47.) In the six months to September, 1877, 'the 
usual summer complaint, diarrhoea, prevailed, during June, Juty, and August.' Two cases of 
dysentery were noted. They were mild in form and treated successfully with ipecacuanha com- 
bined with an aromatic tincture. — (XIV. 05.) In the succeeding months of October and 
November, several cases of diarrhoea, and an unusual number of dyspeptic cases, came under 
notice, but none were of a severe type. — (XV. 21.) 

For the year to March, 1879, diarrhoea as usual heads the list, seconded by dyspepsia. In 
the treatment of the former. Dr. Mackenzie found oxide of zinc most beneiicial, in doses of 
20 grains every four hours to adults and 4 to 6 grains in children. Hsemorrhoidal affections, 
also, were not uncommon. — (XVII. 6.) 

According to the Report for the eighteen months ended September, 1880, during the hot 
season, although few persons escaped fever, there was but little diarrhoea, and no dysentery 
present. In the hot season preceding, the converse was the case ; little fever, but a considerable 
amount of diarrhcea. This comparison is interesting, as the hot season of 1880 was cool and 
moist, while that of 1879 was hot and dry— for Ningpo.— (XX. GO.) In the four months from 
June to September, 1881, diarrhoea existed, although of a type readily amenable to treatment.— 
(XXII. 18.) 

At Foochow, in the six months to September, 1871, cases of dyspepsia were of everyday 

Foocliow. occurrence, and show the highest figures in the table of prevailing diseases. Many 

of them were considered to be symptomatic of torpidity of the Liver. Dysentery 

was not very frequent among the residents, although it and diarrhoea were very common among 



DYSENTEEY AND DIAEEHCBA. 185 

sailors. Eecent cases yield readily to treatment. The type of the disease is asthenic. In the 
treatment, ipecacuanha alone is to be trusted, given in doses of 40 grains with a small quantity 
of opium, and sinapisms applied at the same time to the epigastrium. Dover's powder in small 
doses does good in the interval. In chronic cases the liver is often implicated. In these, benefit 
has been obtained from small doses of castor oil, with enemata of tincture of opium and 
mucilage. Chronic dysentery, however, is frequently associated with organic disease of the 
liver.— (II. 27, 28.) 

In the six months to September, 1872, eighteen cases of dysentery were treated. In all ot 
these, ipecacuanha was well borne except in one, a chronic case. In it all other means failed to 
be successful, and the patient had to be sent to England — the issue not stated. 121 cases of 
diarrhoea occurred; they were chiefly of the summer form, and yielded readily to treatment. 
—(IV. 63.) 

In the Eeport to September, 1875, Dr. Somerville records the prevalence at that port of 
intestinal catarrh, diarrhoea, and dysentery. Many of the obstinate cases of ' diarrhoea ' met 
with there are, in reality, cases of chronic dysentery, with considerable organic changes in the 
large intestine. Summer diarrhoea as met with is not generally obstinate. Cases of it occur 
locally as well as by importation, from Shanghai and from Hong Kong. Dr. Somerville 
writes : ' What is the cause of the great prevalence of diarrhoea during the summer months ? 
It certainly is not the water. Ships carry water from Hong Kong, from Shanghai, and from 
home ; and he observes no difference in the number of cases. He had not noticed fewer cases 
of diarrhoea in vessels using condensed water only. Gunboats use condensed water alone, and 
they have much diarrhoea. The U.S. gunboat Ashuelot had an unusual number of cases 
of intestinal catarrh at Ningpo, in the summer of 1875, although condensed water only was 
used. The residents at this anchorage have drunk the water of the river for years without 
injury.' He thinks, moreover, that ' there is a growing opinion in the profession, especially 
entertained by those who have had much experience in tropical and sub-tropical countries, 
that water containing organic matter has been too heavily blamed as the cause of the 
disease.' The true cause of the diarrhoea afloat is said to be the practice many of the men 
have of sleeping on deck during the night-time, and without sufficient covering over the 
abdomen. 

Dysentery has decreased in frequency of late years, this being considered due to the increase 
of steam over sailing ships, and the improved sanitation of the former as compared with the 
latter. In the treatment of the disease, in one chronic case imported from India, ipecacuanha 
in 40 grain doses was retained ; but not having much effect on it, 3 grains, with 1 of opium were 
-given at short intervals, with good results. In a second case, small doses of the drug did not check 
the disease to any extent. In a third, a 40 grain dose immediately arrested the disease, and only 
one dose more and some pills of Dover's powder were required. In a fourth, a mixture of the 
two methods, i.e. of large and small doses, did well. — (X. 41, 43, 44.) 

According to the Eeport to March, 1876, 'of the deaths that have occurred at Foochow, 
during the last fourteen years, the majority have been caused by dysentery. The fatal cases of 
this disease have been mostly imported. Death has usually taken place by haemorrhage from 
ulceration somewhere between the caecum and lower part of the rectum. — (XI. 39.) 

Dr. Stewart, in 1879, includes diarrhoea and dysentery among the diseases which most 
prevail at this anchorage. The former he has seldom met with separated from some form of 
proctitis ; the latter he looks upon as pure ileo-colitis. — (XVIII. 65.) 

In the six months from October, 1880, to March, 1881, nine cases of dysentery were reported. 

24 



18G EPITOME OF MEDICAL REPORTS. 

All of them proved amenable to the ordinary treatment by ipecacuanha. Summer diarrhrcn 
among children was most tractable to treatment. — (XXI. 53.) 

At Amoy, in the half-year to September, 1872, diarrhoea was the third in order, as regards 
number of cases, of the prevailing diseases. — (II. 7.) In that to September, 
1874, diarrhcea, usually common at the commencement of the hot season, was 
more than usually prevalent among adults and children ; in some cases it was very intractable. 
— (VIII. 67.) In that to the same month, 1880, several severe cases of dysentery occurred, 
one fatal. In it, ipecacuanha in large doses, but failed decidedly to check the disease. — 
(XX I.) _ _ 

At Tamsui and Kelung, from April to September, 1877, only one case of dysentery, and it 

mild in type, occurred. One case of chronic diarrhoea came under observation. Dr. 

^Eeiiiii^° liinger observed that the exhibition of ipecacuanha wine, and spirit of chloroform 

in small and continued doses, with a farinaceous diet, completed the cure, after one 

or two simple doses of the powder had been given. — (XIV. 82.) 

At Swatow, during the half-year ending September, 1872, diarrhoea was unusually prevalent, 
but when uncomplicated with hepatic disease, generally yielded to treatment. When so compli- 
cated, however, it was more serious in its nature. In such cases, treatment con- 
sisted of local bleeding by leeching or cupping ; grey powder, or blue pill and 
bismuth. The same remark applies to dysentery. Dr. Scott seldom had trouble with this 
disease, except when, as is often the case, it is associated with disease of the liver. In such cases 
mercury generally acts well. The usual anti-dysenteric powder in use here consists of 3 grains 
each of quinine, tannic acid, and Dover's powder, taken every four hours. In cases complicated 
with diseased liver, the addition of 2|- grains of calomel acts very well. — (IV. 87.) 

According to the Report to September, 1874, dysentery is not a frequent disease. When 
seen in the acute stage, tho medical officer always gave 1 scruple of jalap with 4 grains of 
calomel, which he found acted admirably ; in the after-treatment he gave small doses of mer- 
cury with chalk and Dover's powder, quinine, and tannic acid, with very good effect. — 
(VIII. 66.) According to that to September, 1870, diarrhcea in children was treated by the 
pyrophosphate, or by the muriate tincture of iron; in such as suffer also from antemia, this 
method was very successful. — (XII. 19.) During October and November, 1877, diarrhoea pre- 
vailed among the foreign community, cholera among the native. Cases of dysentery originating 
in the place were very rare. One of this disease occurred in a lady who contracted it at Saio-on. 
She ultimately recovered, her recovery having been attributed to the influence of the cold 
season. — (XV. 23.) In the summer of 1879, no more than the usual amount of diarrhcea met 
with at that period of the year occurred. Some severe cases of dysentery, as of fever, occurred 
among the resident children. — (XVIII. 75.) 

At Canton, during the half-year to March, 1878, a few cases of dysentery and chronic 

diarrhoea, and one case of ulcerative stomatitis in an adult, came under notice. 

One foreign infant, aged fifteen months, died of dysentery connected with dentition. 

— (XV. 13.) In the summer of 1879, diarrhoea and dysentery occurred among foreigners, and it 

was observed that the peculiar form of remittent fever which then prevailed frequently attacked 

persons convalescent from these diseases. — (XVIII. 56.) 

According to the official Report by Dr. Simmons on diseases in Japan, 90 per cent, of the 

cases of dysentery admitted at Yokohama occurred in non-residents. Of diarrhoea, 83 per cent. 

Ja an ^^^'® ^'®° among non-residents. In all these cases the attacks of dysentery and 

diarrhoea were severe ; but such cases of these affections respectively as occurred 

in residents were mild. — (XV. 61.) 



SPRUE. — PROCTITIS. 187 



XLVII. SPEUE. 



The disease so named has long been known in India and in Java. The term is sometimes 
applied to the thrush of infants associated with the development of oidiuni albicans in the mouth. 
Sprue, however, is entirely confined to adults. Its symptoms are referable — (1) to a remitting 
inflammation of the mouth and alimentary canal generally ; (2) to diarrhoea and irregular action 
of the bowels; and (3) to ansemia and general atrophy. lb is peculiar to hot climates. During 
an exacerbation, the tongue is more or less swollen, papillte elevated, shallow ulcers on the cheeks, 
tongue, and lips; saliva, rapidly accumulating, runs from the mouth while being examined; 
tongue abnormally clean; no foetor. The oesophagus becoming implicated renders swallowing 
difficult. Both the inflammation in the mouth and the diarrhoea are periodic. At times the 
diarrhoea is semi-choleraic in character, the attacks most frequent at night, occasionally also 
with diarrhoea; there is great sense of languor, tympanitis, and borborygmi. The evacuations 
usually are pale, clayey, frothy. There is great emaciation ; the patient is feeble, irritable, 
incapable of much mental effort, and ansemic. The progress of the affection is slow. Eemoval 
to a cold climate is absolutely necessary ; medicine and diet, though they may mitigate, will not 
cure the disease so long as the patient remains under the conditions in which it was contracted. 

The cause of sprue lies in the general unsuitability of the European constitution to tropical 
climates. In China, age and residence have a marked influence as predisposing causes. Of five 
cases recorded, the patients were over thirty-five years of age, and had been over ten years in the 
country ; their habits differed, from free-livers to teetotalers. At Shanghai and other northern 
places, patienis improve during the cold weather. The reporter has never seen sprue in a native. 
In Batavia, the affection is generally associated with cirrhosis or other disease of the liver. 

In the treatment, bismuth and strychnine during the remissions, and bismuth and morphia 
during the exacerbations, are of some service as palliatives. Wine and spirits should be given 
much diluted. Other remedies recommended are grey powder, soda and rhubarb ; taraxacum 
with alkali.— (XIX. 33.) 



XLVIII. PKOCTITIS. 

At Foochow (1879), according to Reports, not a summer passes without several cases of 

proctitis, aggravated sometimes by an extension of rectal inflammation into the colon. Its results 

vary in severity from simple diarrhoea to dysentery in the gravest form. Proctitis 

is usually most obstinate, and may continue for years ; its persistency increasing 

as inflammation approaches the inner edge of the sphincter ani. It attacks children at Foochow, 

but has not been met with among them elsewhere in China. It generally attacks those of from 

six months to five years of age; but has been met with in a child of ten. Its attack is usually 

sudden. While at play a child may have a loose evacuation; then another, and so on. The 

stools soon are tinged with blood and mucus ; then they are entirely of blood, passed with much 

pain and straining. The constitutional disturbance is at first small in proportion to the amount 

and character of the evacuations ; a sudden and great sinking then occurs. On examination, the 

sphincter will be found inflamed, ulcerated, or sloughing, according to the severity of the disease. 

—(XVIII. 69.) 

24—2 



188 EPITOME OF MEDICAL REPORTS. 



XLIX. HERNIA. 

lu the Report ou HankoWj January to Marchj 1872, some particulars are given regarding 
hernia. It is stated that in cases of scrotal swellings attended with much pain, whether due to 
hernia or to hydrocele, acupuncture needles are, by the Chinese, inserted a short 
depth into the wall of the abdomen on the left side, midway between the 
umbilicus and the anterior-superior spine of the ileum, or a little in front of the cartilage of the 
ninth rib, or into certain parts of the leg or foot. It is believed that these places are special 
gateways that allow a super-abundance of air to escape, which is supposed to have collected in 
quantity in the textures of the scrotum, and impeded the circulation therein. — (III. 50.) 

At Chinkiang, according to the Eeport to March, 1880, inguinal hernia, direct or indirect, 

appears to be common among the Chinese, and no desire exists to remedy the disease ; in 

fact, little inconvenience appears to be experienced unless the hernia assumes 

a very large size, and then only relief is sought. Dr. White has not seen or heard 

of a case of strangulation, and very few cases present themselves in which the protrusion is 

not easily reduced. — (XIX. 7.) 



L. AFPECTIONS OP THE LIVEE. 

At Peking, according to the Report to September, 1872, an epidemic of jaundice occurred in 
September and October, 1861. The disease is said to occur in each spring and autumn season. 
On the occasion named, the cases, although numerous, were slight in the great 
majority; in a few, however, the accompanying fever was severe, and the attack 
issued in anasarca. Not only was the capital visited by it, but the disease also extended to the 
two provinces west of Chihli. The treatment pursued consisted of purgatives according to 
circumstances. — (IV. 40.) 

According to the Report on Hankow to March, 1872, hepatic abscess is very rare in this 
part of China ; yet the summers are hot and variable, the natives extremely poor, and exposed 
to the inclemencies of the season, while their habits are less distinguished for 
sobriety than is generally supposed. Among foreigners in past years two deaths 
occurred from this disease. — (III. 52.) In that to September, 1873, details are given of three 
cases of hepatic abscess, all of which occurred in the summer half-year included. In one, the 
patient died of gangrene supervening upon the application of a blister. In the second, forty 
ounces of pus were discharged by means of the aspirator, subsequently twenty ounces more. 
Under the use of muriate of ammonia, the patient so far recovered as to return to his home. In 
the third case, the symptoms of abscess are stated to have spontaneously disappeared under 
the use of muriate of ammonia. — (VI. 84, 35.) 

At Shanghai, in 1871, hepatitis was common among foreigners ; but that form of the 
Shan bai ^isease which rapidly runs on to suppuration is rare, and usually occurs in 
arrivals from the south. Cirrhosis, or gin-drinker's liver, is rare — indicating 
thereby the relative absence of excessive drinking among the residents. — (II. 40.) 

According to the Report on that place to March, 1873, the medical officer says : ' If it be 
true that hepatic abscesses following dysentery and other ulcerative affections of the intestinal 
canal are generally multiple, while those which result from non-specific hepatitis are single, 



AFFECTIONS OF THE LIVER. 189 

tlie advisability of operative interference in a given case will depend materially upon the previous 
history. — (V. 67.) These remarks are illustrated by a case recorded in the Eeport for September 
of that year. — (VI. 64.) 

In 1874, a case is recorded in which a man suffered merely from persistent high temperature 
(102 to 103"5° Fahr.) and wasting, but had no other symptoms. He was subjected to exploratory 
puncture with an aspirator; an abscess was then discovered to exist; the contents were evacuated 
at intervals several times, but the patient died.— (VIII. 17.) 

In the Eeport to March, 1876^ Dr. Jatnieson wrote, in regard to instances in which the 
symptoms pointed to suppuration of the liver, and yet recovery took place, thus: 'A high tempera- 
ture in hepatitis is not an indication of suppuration.' In a case of hepatic abscess published by 
Maclean {Lancet, 1873; ii. 39), the highest temperature recorded was 99-9°. The highest 
temperature in a case noted by Dr. Jamieson was, before operation, 102° Fahr. — (XI. 54.) 

At Foochow, in 1871, organic disease of the liver was in nearly every case imported. 
The most frequent forms were acute and chronic inflammation, resultina: in hyper- 
tropny, abscess, or atrophy. In the treatment of these conditions, mercury was 
inadmissible ; nitro-muriatic acid internally, locally, and in baths was given. In all, change of 
climate became necessary. — (II. 31.) 

In the six months to September, 1872, cases of persons were by no means uncommon, where 
after death the liver and spleen are found to be extensively diseased, without any other symptoms 
during life having appeared than those of functioual disorder. — (IV. 60.) 

In the Eeport to September, 1873, Dr. Stewart observed that jaundice was not uncommon, 
'while what is called " liver " is what every man is certain he has as often as he is dyspeptic, or 
has any pain on the right side, or even on the left. The word " liver " ' — he writes — ' is a great 
invention ; it explains so many things.-' — (XVIII. 65.) 

At Amoy, in the period to September, 1871, three cases of congestion of the liver from 
exposure were mentioned ; also one of hepatitis and fever imported from Swatow, and one of 
jaundice. — (II. 12.) A case of hepatic abscess was reported in 1878. The subject 
of the disease, a Custom-house employe, at the time in delicate health, was in 
February suddenly seized with acute hepatitis at Shanghai. The case ran the ordinary course. In 
its latter stages the abscess was ' aspirated,' then on two occasions punctured with an ordinary 
trocar, pus being each time evacuated. The patient sank, however, and died on 5th of June. It 
appears that no dysenteric complication was present, and that for a considerable period the case 
had the character of one of intermittent fever. — (XVI. 12.) 

In the Eeport to March, 1882, the remark occurs that hepatic abscess is some- 
what rare among the native Chinese at Takow and Taiwan-foo. — (XVIII. 21.) 

In the Eeport on Swatow from April to September, 1874, the medical officer wrote : ' With 
regard to congestion and inflammation of the liver, he gladly expresses his belief in the great 
value of local blood-letting. Cupping is to be preferred to leeches, as the quantity 
of blood taken is accurately known. — (VIII. 66.) In the period to September, 
1877, a case of biliary calculus occurred in the person of a foreigner; the case itself interesting 
as showing the value of a full dose of morphia in arresting the spasm of the choledic duct, and 
immediately freeing the patient from all pain. The subject of the attack was a lady thirty-five 
years of age. — (XIV. 73.) In that ending September, 1881, in the Seamen's Hospital a case 
of hepatic abscess terminated fatally ; aspiration was performed, but the patient, a young 
engineer, of temperate habits, was moribund on admission. — (XXII. 5.) 

At Canton, in 1879, two cases of congested liver were treated among the foreign residents. 



190 EPITOME OF MEDICAL REPORTS. 

A case of hepatic abscess in the person of a missionary from a place in the district described as 
low, damp, and malarious. He also was affected with enlarged spleen. — (XVIII. 57.) 

In the Reports having reference to Japan, from 1868 to 1875, it is impossible to separate 

cases of hepatic disease assumed to be due to climatio causes or complicating other diseases, from 

those considered to be due to individual causes, as excessive indulgence in spirituous 

hquors. From 1875 to 1877, such a distinction was made, and during that 

period none appear to have occurred in residents except such as were traceable to individual 

causes. — (XV. 62.) 

LI. VESICAL CALCULUS AND KIDNEY DISEASE. 

Vesical calculus is comparatively rare in China, except in Kwang-tung and Kwangsi. In 
those provinces, the rivers flow through districts rich in lime; the large majority of cases of the 
disease occur in boatmen and farm-labourers, both of which classes use the river- 
water in cooking and as a drink. The condition of system which leads to the 
affection is conjecturally assigned to malaria and peculiarities of food-articles used by the natives. 
It has not been found that foreigners, even after long residence in Kwang-tung, suffer from the 
affection. In the belt of country extending south-west of Canton, and running into Siam and 
the Laos region, the natives are very subject to it. The varieties of calculus recorded in the 
Customs reports include only two — namely, that composed of phosphates and that of uric acid. 
Usually the Chinese apply for treatment on this account only after they have exhausted their 
own means — namely, the moxa and actual cautery to different parts of the abdomen. In cases 
where lithotomy is performed, the wound usually heals rapidly ; in one instance by the first 
intention. According to a table given, the composition of the calculus was phosphatic in only 
3 out of 140 cases recorded ; uric acid in all the rest. — (XVIII. 52.) 

At Peking, in the Report to .31st March, 1873, the medical officer notices the absence of 
calculous diseases in that capital, and he considers that the remark applies to the north of China 
generally. This absence, however, appears to be relative rather than absolute, as 
two cases of the affection are noticed in that document. One of these, however, 
was really a calculous incrustation over a fragment of lead. The patient had practised intro- 
ducing leaden bougies into the urethra for ten years, with a view of strengthening his constitu- 
tion and preventing spermatoi'rhoea. He was an opium-smoker. Lead bougies rubbed with 
mercury are likewise used in gonorrhcea and other affections of the urethra. These practices are 
said to form part of the observances of one of the Taoist sects in Mantchuria. — (VI. 11.) 

In the Report for Kiukiang for the year ending 31st March, 1877, Dr. Jardine gives some 

remarks in relation to a case of this nature. The patient had been in China since 1859. As a 

^,. , . missionary among the Chinese he lived on their food, and it contained a good deal 

Kiukiang. .... ° 

of vmegar or other acid ingredients. In August, 1875, he experienced the first 
symptoms of his illness. A Chinese doctor 'gave him a little relief by his treatment.' In June, 
1876, however, his symptoms became aggravated; uric and renal calculi were passed by the 
ui-ethra ; his urine was acid, and deposited urates, with phosphates and mucus. From that time 
he estimated that he voided 1,500 small calculi. He was treated according to the method of Dr. 
Roberts of Manchester, namely : 

IJ; Potassse bicarb., 1| ounce. 
Acidi citrici, 504 grains. 
Aquas ad 12 fluid ounces. 



VESICAL CALCULUS AND KIDNEY DISEASE. 191 

The dose of such a solution is six to eight fluid drachmSj with three or four ounces of water. 
Two table-spoonsful every three or four hours. Diluents to drink ; to avoid much animal food^ 
vinegar, and wines, and to live on farinaceous diet. 

Under this treatment the discharge of calculi by degrees ceased, and recovery gradually took 
place. Dr. Jardine adds, however, 'What part the change from Nan-an-fu to Kiukiang may have 
had in producing these happy results I am unable to say.' — (XIII. 3.) 

Stone in the bladder is uncommon at Shanghai; alike in foreigners and in native residents. 
In one case recorded in the Report for April to September, 1877, the composition of the calculus 
was chiefly urate of soda ; in a second case recorded, oxalate of lime with uric acid. „, , . 

-r, . . . . Shanghai. 

Dr. Jamieson had only met with two cases among foreigners, and had never met with 
-any among the Chinese. The flrst of these was attended by severe nephralgia calculosa, 
and the calculus was so friable that, in sounding to ascertain its size, it fell to pieces. In the 
second, the composition of the concretion was oxalate of lime with uric acid ' diffused' deposit. — 
{XIV. 49.) 

At Ningpo, for the eighteen months ending 30th September, 1880, the medical ofiicer was 
struck by the absence among the members of the community of the habitual deposit of urates in 
the urine — the condition termed lithuria ; whereas at Chefoo it was frequently 
found among foreigners. This difference is ascribed to the mere change of locality, 
and to the difference in the climates of the two places ; that of the north being dry, that of the 
south moist. Urea, he observes, is generally admitted to be formed in the liver. — (XX. 27.) 

At Takow and Taiwanfoo,' during the half-year to September, 1871, one case of urinary 
calculus occurred. The patient had been about two years resident in Formosa; the 
concretion was small, and was voided by the urethra. — (II. 67.) 

According to the Report on Canton to September 1871, stone in the bladder was extremely 
common in that province, although it is not met with in Amoy, Foochow, Shanghai, Ningpo, 
Hankow, or Peking. Ever since the establishment of mission hospitals at Canton, 
many operations for stone have been annually performed, but of late years the 
number has increased. From 1856 to the end of 1870, there were 217 cases operated upon in 
the hospital under Dr. Kerr's care. Of the cause of the prevalence of calculus here, as well as its 
absence from the places named, Dr. Wong is unable to give a satisfactory explanation. He 
observes that it is equally diflScult to account for its prevalence in some parts of Eugland more 
than others. The causes and conditions favourable to the production of stone are supposed to be 
humid climates and moist localities. With regard to the influence of certain kinds of water and 
of spas in inducing stone, it has been found that none of the forms of calculi correspond with the 
salts that exist in natural waters. In addition to this, the Chinese always drink boiled water, 
the lime of which in the process of boiling settles at the bottom of the kettle. As the causes and 
conditions here enumerated exist more or less in other parts of China — as, for example, at Amoy 
and Shanghai — the wonder is, not the presence but the absence of the affection from the other 
parts of the empire. The gouty diathesis appears to have little to do with the prevalence of 
calculus, as gout is scarcely ever met with among the native population. A large proportion of 
the patients thus affected were farmers. — (XI. 71.) 

At Yokohama, calculous diseases appear to be almost unknown. In ten years, one case 
only was admitted into hospital there — that of a non-resident j the records of ^^ 
the cemetery contain few cases ; nor have they been met with in private practice 
save when imported. — (XV. 63.) 

BrigU's Disease.— In the Report on Kiukiang to March, 1877, details are given of a case 



192 EPITOME OF MEDICAL REPORTS. 

of this affection. It occurred in a member of the outdoor Customs staff, who had passed 
fifteen years in China, and whose habits were described as intemperate. With one 
or two exceptions the plan of treatment followed was the ordinary one. He was 
directed to desist from spirits and wines, and to live upon milk and light nutritious food. At 
first perchloride of iron was administered. Digitalis, bismuth, and magnesia were given 
according to indications. Horse-radish tea, as used by Rayer, was tried, and as a diuretic it 
proved more valuable than the bitartrate of potass, for under its use the dropsy disappeared, 
and did not return. Eventually the patient was sent away to sea. — (XIII. 1.) 

At Yokohama, during ten years, cases of ' Brighfc's disease' formed 1'3 per cent, of the total 

cases, the mortality in the former being 26 per cent, of cases. Of the entire number, 2'7 per 

cent, occurred in residents, 9r3 in non-residents. From 1871 to 1877, the deaths 

Japan. 

by diseases of the kidney reached 2 '4 per cent, of the classified mortality, 50 per 
cent, of these being non-residents. Medical men at Yokohama consider that cases of the graver 
forms of diseases of the kidneys which occur there, are, as a rule, dependent upon individual 
causes, such as dissipation and old syphilitic affections ; also, that they are not of more frequent 
occurrence there than they are elsewhere. — (XV. 63.) 

LII. SKIN DISEASES GENEEALLT. 

At Amoy, next to syphilis and leprosy as causes of skin disease, come skin parasites, animal 

and vegetable, all of which, except dracunculus and microsporon Aicdouini, Dr. Manson has met 

with there. Two skin diseases common in corresponding latitudes in other parts of 

Amoy. . . 

the world are there absent, namely frambaesia and pellagra. Bad rice and cereals 
of different kinds are consumed in abundance, but maize does not appear to enter largely into 
the dietary of many of the people. Eczema, psoriasis, acne, lupus, and so on, are stock diseases, 
as they are at home. Keloid and elephantiasis are unusually common. Molluscum contagiosum 
is not a common disease in China. 

The liability of cicatricial tissue to assume a keloid character in the dark-skinned races has 
been already noticed (p. 149) in relation to cancer. The Chinese, in this respect, perhaps, occupy 
a position intermediate between the negro and the European. 

Dr. Manson, at Amoy, met with ' an excellent example of that rare form of pntyriasis versicolor, 
known as pityriasis vigra.' He alludes to 'the frequency with which Chinese and foreigners 
in China are attacked with chloasma.' — (XXI. 27, 33-35.) 

At Kiukiang, according to the Eeport to March, 1881, cutaneous disease ranked, as regards 
prevalence, next to malarial fevers ; this beinof due in no small measure to the 

Kiukiang. ^ ... 

filthy habits and indigent circumstances of the people, conjoined with their utter 
neglect of all sanitary precautions. — (XXI. 48.) 

At Yokohama, certain parasitic and contagious skin diseases prevail extensively among the 
Japanese ; and foreign residents are considered to be more subject to these 
affections than in either Europe or America. They are but seldom serious, how- 
ever, and for the most part yield readily to treatment. 

Prurigo appears to be occasionally met with in a troublesome or aggravated form among 
foreigners in Japan. It appears to depend entirely upon climatic conditions. Some cases 
yield readily to treatment. In others, change of climate effects benefit for the time being, 
although the affection recurs on the return of its subject to Japan — often in so aggravated a 
form as to render life a burden. Natives as well as foreigners suffer from this disease. 
—(XV. 63.) 



URTICARIA. — PRICKLY HEAT. — ECTHYMA. 193 

LIII. UBTICAEIA. 

At Newchwangj during the winter of 1878-79, a case of urticaria occurred. In it the 
affection was considered as due to gastric irritation. Not only were the symptoms very urgent, 
the fever running high for several days, but for some years previous the patient ^^^ 

had suffered from a similar attack every winter. In the treatment, emetics and 
purgatives were used with good effect, and the warm bath containing a little carbonate of soda 
was very soothing. Carbolic oil applied at night relieved the irritation and procured sleep. 
Stomachics and general tonics were given during convalescence. — (XVII. 10.) 

On the subject of urticai-ia, Dr. Jardine, in the Report on Kiukiang for the year ending 31st 
March, 1876, writes, that ' a dose of laxative medioine and two baths of pinewood shavings were 
sufficient to permanently cure the disease.' The pine (san, sha-muh) flourishes in 
the southern, central, and western provinces of China, and is much used for house- 
fittings on account of its proof against erosion by insects. Dr. Jardine has used it in obstinate 
cases of prurigo, and, with constitutional remedies, it was equally effectual as in urticaria. — 
(XI. 15.) 

LTV. PEICKLY HEAT. 

According to the Report on Peking to September, 1871, the absence of prickly heat in 
summer among the native Chinese is assigned to their mode of life; namely, to the circumstances 
that they avoid cold bathing, but use the tepid bath ; that they are generally tem- 
perate; and they do not use flannel. Europeans during each hot season suffer 
much from this affection, the skin-sensibility in them being said to be much increased by the use 
of stimulants. — (11. 80.) 

At Shanghai, from April to September, 1872, prickly heat was frequently met with during 
July. The heat of the nights during the first three weeks of that month was very 
great, so that foreigners, old and young alike, obtained little sleep ; perspiration was 
at the same time profuse, and prickly heat very prevalent. — (IV. 93.) 

In the Report of Foochow from April to September, 1877, it is stated that for the first time 
a remedy has been found for the affection named. The remedy in question was indicated in the 
Lancet (vol. i. for 1877, p. 672), and consists of the following ingredients, namely : 
sublimed sulphur, 80 parts; magnesia, 15 parts; oxide of zinc, 5 parts. The 
skin is first bathed with warm water and a little soap ; some of the powder is then planed in a 
saucer, and a squeezed sponge pressed on the powder. A portion of the powder will adhere 
to the sponge ; this to be rubbed carefully in all the patches of prickly heat, and the process to 
be repeated morning and evening. — (XIV. 88.) 

LV. ECTHYMA IN WOEKEES AMONa SALT ; ALSO LACQUER ECZEMA. 

This affection is mentioned in the Report on Chinkiang for the year ending 30th September, 
1873. It is said to be peculiar to women engaged in smuggling salt, and is by them attributed 
to their daily habit of carrying large quantities of that commodity in their girdles 
directly upon their skin. Besides the local eruption, the subjects of the affection 
suffer from a febrile condition and anaemia. There is great local itching ; and in extreme cases 
extensive and obstinate ulceration supervenes. Dr. Piatt considers that many of the symptoms are 

25 



194 EriTOME OF MEDICAL REPORTS. 

due to the absorption of salt in sucli quantities as to prduce serious constitutional disturbance, 
quite aside from any eifect it may have as a local irritant. — (XVI. 20.) 

In reference to the disease known in Yokohama as lacquer eczema, Dr. Simmons wrote: 'The 
botanical relations of the Rhus vernicifera, from which lacquer is derived, are very close to the Ameri- 
can species, R. venenata or R. toxicodendron, while the effects of all three species are 
°'""°' alike. Chemical examination indicates that the irritant effects produced are due 
to the presence of a volatile toxicodendric acid ; hence the occasional occurrence of the poisoning 
without actual contact taking pi ace, as also the fact that lacquer becomes innocuouswhen thoroughly 
dried and hard. The means oE prevention have, however, been long empirically known — namely, 
alkalis and certain chemical agents which form insoluble compounds with toxicodendric acid. 
Of these, the acetate of lead appears to be most abundantly used. The effects of the poison may 
manifest themselves within twenty-four hours, or not for several days. The hands and face are 
the parts most frequently attacked. The symptoms may be erysipeloid or eczematous ; the 
symptoms of all degrees of severity, in cases of greatest intensity obstinate and extensive purulent 
ulceration taking place. The affection is described as being pseudo-contagious; that is, the 
poison before its absorption by the skin may be transferred to others, or from one part of 
the patient's body to another ; but once it has taken full effect, it is no longer contagious.' 
—(XV. 67.) 

LVI. DISCOLOEATIONS. 

Chloasma or Pityriasis versicolor. — In fair-skinned races this affection appears as a brown or 
fawn-coloured patch on a light ground. In the dark-skinned races as a lighter-coloured patch 
on a light ground. — (XXI. 29.) 

In the yellow-skinned races, like the Chinese, the patch of the disease and general complexion 
so nearly correspond, that close observation and the microscope are necessary for correct diagnosis 
of the affection. A large number of the native Chinese coolies have patches of chloasma about 
the neck, chest, shoulder, and abdomen, under the waist-belt ; these giving them often a mottled 
appearance. — (XVI. 9.) 

Morphcea is by some writers asserted to be a phase of leprosy. Pale, circular, waxy-looking 
patches, devoid of hair and sweat-glands, with a vascular border and slightly depressed and 
ansesthetic centre are often seen, but always in connection with unquestionable evidence of 
leprosy.— (XXI. 29.) 

In the Eeport on Shanghai for the period ending September, 1871, the 
occurrence of one case of ' Addison's disease ' (Melasma) is casually mentioned. 
—(II. 37.) 

LVII. ULCEES. 

At Kiukiang, April to September, 1872, some cases of ' Cochin China ulcer ' were recorded. 
In two of these the disease so described consisted of deep burrowing sinuses in the foot- in 
two, of ' a patch of chronic callous ulcers on the sole.' According to Dr. Rochard 
the French soldiers in Cochin China suffer from this affection in the proportion 
of one in eight men. The parts around the ulcers are always more or less ansesthetic, as in 
leprosy; the ulceration often penetrates tu tlic tendons and bones; and resists all fcreairaent until 
the subject of it is removed from the malarious locality where the disease began. — (IV. 4-6) 



ULCEUS. — BOILS. 195 

At Hankow^ according to tbe Eeport to March, 1881, the ulcers admitted into hospital were 
either hopeless in their nature, unless treated, or they had features of special interest. Many of 
them were only admitted in the belief that they would prove cases for amputation. 
Skin-grafting proved very successful in many instances. Once, during the excision 
of a largo portion of the eyelid in a severe case of entropion, the idea occurred to try the excised 
portion on a healthy ulcer then in the ward. The result was surprising. The piece of skin, 
one inch long by half an inch broad, took, the cuticle merely coming off like a white film, the 
raised patch remaining red and healthy, sending out young epithelium in all directions, and 
completing the cure. — (XXI. 46.) 

In the Eeport on Poochow for the six mouths to September, 1875, Dr. Somerville mentions 
a simple and effective method of treating ulcers which he had used for a considerable time. A 
piece of the leaden lining of a tea-box is beaten out smooth and laid carefully 
upon the ulcer, covering also the adjoining parts, several folds of lint applied so 
as to absorb the purulent discharge. This method of treating chronic ulcers was first intro- 
duced by Mr. Syme of Edinburgh, many years ago. As to the modus operandi, explanation does 
not occur, but 'at all events, there is no doubt about the result.' — (X. 44.) 

In the Report for 1879, the ulcer peculiar to Foochow was thus described. It is usually, 
though not invariably, an accompaniment of the hot season. It begins, to all appearance, spon- 
taneously, or after a scratch or mosquito bite. It usually affects the leg, especially the part 
over the shin-bone, or ankle. Redness and surrounding inflammation increase rapidly, and 
the sore itself assumes a gangrenous appearance. The curative process is very tedious and 
unsatisfactory.— (XVIII. 69.) 

At Takow and Taiwanfoo, in 1871, Dr. Manson tried by means of transplantation of skin to 
accelerate healing of the chronic ulcers which are so common there. His great diSiculty at first 
was in the management of the dressings. Having had to change these at least 
twice a day, the small portions of skin were displaced and lost. To obviate this Taiwanfoo 
difficulty he placed over the ulcer, immediately after transplanting the skin, a 
piece of fine gauze previously soaked in carbolic acid. Over this a couple of folds of lint with 
carbolic acid, a piece of silk, and then a bandage. When the dressings were changed everything 
was removed except the gauze, when the surface of the ulcer was cleaned by pouring water over 
it, after which the new dressings can be adjusted without displacing the particles of skin. 
Several cases were successfully treated in this manner ; but Dr. Manson found that frequently, 
after all had been going on well for several days, the ulcers, notwithstanding the use of quinine, 
took on a sloughing action, and thus more time was lost than gained. ' On the whole, he has 
leaimed that these ulcers can be healed as speedily by ordinary local applications and the 
administration of tonics, especially iron, and nourishing diet. Beef-tea will often be efficacious 
where drugs have failed.' — (II. 69.) 

LVIII. BOILS. 

At Kiukiang, during the autumn of 1874, foreigners and natives suffered from an epidemic of 
boils. Sometimes the boils were large and solitary, but more frequently they appeai'ed in successive 
crops. In some instances their appearance was preceded by sharp fever lasting 
twelve hours ; more generally the health was unaffected, and only the local incon- 
venience experienced. The maturation of the boils occupied six or seven days ; sometimes the 
lymphatic glands became affected ; and in persons of scrofulous diathesis livid marks or scars 
remained after the discharge of the contents, whether naturally or by artificial means. 

25—2 



196 EPITOME OF MEDICAL BEPORTS. 

Eegarding the etiology of boils at this settlement, Dr. Jardine considers that they are among 
the results of malaria. He observes that on one or two occasions neuralgia preceded their 
appearance; that many persons had an attack of fever ushering them in; that if there was a 
recurrence of the fever no boils appeared, but that when boils presented themselves there was 
an end of the fever. He observes that in certain malarious districts in America, the occurrence 
of boils is considered a safeguard against an attack of intermittent fever. In the constitutional 
treatment of some of the cases at Kiukiang, many remedies were tried with which boils have 
been most successfully treated in Britain, without any result but disappointment. Quinine in 
combination with sulphate of magnesia and sulphuric acid, or quinine by itself, was found beneficial 
in all cases, not only in hastening suppuration, but in preventing a recurrence of the attack. 
Liquor arsenicalis in conjunction with wine of iron also proved curative, especially in children, 
when the disease was associated with antemia. With regard to tins question of opening the boils, 
or ' adopting the expectant plan,' each case must be considered on its own merits. It is 
observed, however, that 'incisions had the disadvantage of leaving an ugly scar.'' — (IX. 1.) 

At Shanghai, April to September, 1872, the reporter wrote in reference to boils, that among 
the summer ailments they stand pre-eminent. They are really small carbuncles, and are at times 
attended by much constitutional disturbance. Powdered camphor applied to the 
""^ "'■ ulcer which is left behind after opening the boil, whether artificially or naturally, 
promotes rapid healing. He is inclined to think that this is a Chinese remedy, as it was first 
suggested to him by a Chinese. The general symptoms are to be treated with tonics and 
generous diet. — (IV. 96.) 

At Poochow, 1871, boils were very prevalent throughout the hot season, and all classes of the 

country suffered from them. New comers and persons recovering from illness were particularly liable 

to them. Persons of phlegmatic temperament were more liable to them than those 

of bilious diathesis. To ladies they are especially annoying, on account of the 

disfigurement they cause, and the train of irritative symptoms to which they give rise. Instances 

of true carbuncle are very rare. — (II. 26.) 

At Tamsui, according to the Report for the year ended September, 1878, several 

cases of malarious fever were followed by a large crop of boils. — (XVI. 18.) 

At Swatow, in 1871, boils were very prevalent during summer ; one man has had 200 during 

the season. The distress and weakness caused by their suppuration and discharge 

are very great. — (II. 9.) 

According to the Report for the six months to September, 1872, the occurrence of boils was 

considered due to miasmatic causes. In the treatment of these affections the medical officer 

gave alkalis ' in deference to John Hunter,' but with no special effect ; other remedies and 

methods of treatment usually recommended had no better result, and the remark occurs that ' we 

are badly in want of more knowledge of the origin and pathology of this complaint, as, in the 

south of China, it is a common and hitherto very unmanageable disease.' Poultices seem 

rather to promote the further formation of boils, though they give great relief as regards the 

particular boil to which they are applied. Support by adhesive plaster is also useful to 

individual boils, giving great relief, and seeming to hasten the suppurative process and the 

ultimate discharge of the core. Sulphate of quinine with diluted sulphuric acid failed in the 

hands of Dr. Scott, who thinks, however, that the disease ought to be treated constitutionally, 

and that a generous regimen with malt liquor and tonics are the best remedies. — (IV. 88.) 

In the half-year to September, 1877, Dr. Scott had not one case of boils to record, although 
generally in summer he had met with many instances of this troublesome and painful affection. — 
(XIV. 69.) 



CARBUNCLE. — GAKGRENE FEOM COLD. 197 

At Canton, according to the Eeporfc— April to September, 1872, boils occur every summer 
among the younger of the foreign community. The remedies suffa-ested for 

+ 1 ■ £f ,. , ° . , ■' °° Canton. 

tnis anection are numerous ; but tonics and alkalis seem to have the preference. 

In children, the weakly are not more liable to them than the strong. In their treatment the Chinese 

do not use the knife, but apply plasters having caustic properties. — (IV. 69.) 

In the summer of 1877, some of the foreign residents, both adults and children, suffered 
severely from boils. — (XIY. 58.) 

LIX. CAEBDNCLB. 

At Peking, according to the Eeport to 30th September, 1871, carbuncles are at all times very 
frequent among the Chinese, being usually also large in size and numerous on the same person. 
Their subjects for the most part were elderly persons of debilitated constitution ; p i^- ^ 
the mortality by them great. According to the nosology of the Chinese, carbuncle 
is classed among the cancerous, malignant, and other sores. The usual treatment pursued in 
the Consular dispensary was that by free crucial incision. The popular name here for carbuncle 
is shang or hia ta, according as it is situated on the upper or lower part of the back. The term 
ta pei is also used, but the proper book expression is fah pel, denoting an issuing or springing 
forth of the spinal column. Several varieties are mentioned and named according to their 
position on the body. — (III. 7.) 

At Foochow, April to September, 1877, a case of severe carbuncle was reported. The subject 
of the affection was an English sailor, forty-seven years of age. There first appeared an abscess 
in the neighbourhood of the perineum, which was opened, and 10 ounces of pus evacuated, the 
wound healing, but not kindly. Then followed two carbuncles, which both occupied the whole of 
the back, with carbuncles of smaller size, and abscesses in various parts of the body, the patient 
ultimately sinking under his ailments. In the treatment of one of the large carbuncles, free 
incisions and poultices were employed, but the results were not looked upon as encouraging. Dr. 
Ringer quoted the views of Sir James Paget as to the objections against the former practice of 
treating carbuncle by means of free crucial incisions. — (XIV. 87.) 

At Canton, 1879, a case is given of intensely severe carbuncle. The disease first occurred in 
the usual position at the back of the neck ; the tissues all round the neck became affected, 
incisions had to be made, but extensive sloughing set in, and the patient speedily 
sank. The subject of the disease was Dr. Wong. His life had been a most useful 
and active one, and he had practised his profession for nearly twenty years at this place. — 
(XVIII. 57.) 

Malignant Pustule. — In Japan this disease, though occasionally seen in natives, is rare among 
foreigners, only one death by it being registered between 1871 and 1877. — 
(XV. 55.) *^''°' 

LX. GANG BENE PEOM COLD. 

In the Eeport on Newchang, October, 1880, to March, 1881, it is stated that in the beginning 
of winter a good many cases of frost-bite occur in the crews of Siamese vessels. Dr. Watson has 
not observed a Chinese or European sailor so affected. But the Siamese often suffer 

... . . i Newcliwang. 

from frost-bite before the temperature is at the freezing-point, so sensitive are they 
to even moderate cold. Cases in illustration then follow. — (XXI. 39.) 



198 EPITOME OF MEDICAL REPORTS. 

At Chefoo, during tlie six months from October, 1875, to MarcTi, 1876, gangrene from cold 
formed no small proportion of the cases occurring on board Siamese vessels. The affection is 
generally met with early in October, when the winter winds begin to set in. The 
parts atracked are the hands and the feet, more frequently the latter. The men 
most subject to it are the cachectic and the debilitated, it being very rare to find the condition 
among the well-nourished and the robust. Among European seamen, the particular affection under 
notice has not been seen, although during intensely cold weather they are sometimes affected 
with swelling and blisters of the hands, from which they speedily recover without any bad 
symptoms. It is chiefly among Siamese, Malays, or Lascars that this affection is found. It is 
remarkable what a small degree of cold proves the exciting cause of this lesion. It has been 
seen to attack a ship's crew who had previously been comparatively healthy, after night and 
exposure to a temperature of 45° Fahr. The ordinary history of a case of this gangrene on board 
one of these vessels is that a seaman on watch is exposed to the cold until he feels uncomfortable, 
and as soon as opportunity offers he repairs to the cookhouse or to a charcoal fire to warm himself. 
As may be expected, the reaction is severe. All the symptoms of inflammation supervene, and 
unless it soon subsides, we have gangrene taking place. In mild cases the disease does not 
extend beyond the toes or fingers, but not uncommonly the whole foot becomes involved, spread- 
ing, it may be, above the ankle or near the knee. This form of gangrene is seldom accompanied 
by severe constitutional symptoms, except in some cases, during the first few days. There is very 
little fever or other general disturbance. The local disease does not generally encroach beyond 
the first observed defined mark of the discoloration of the skin, and the line of demarcation takes 
place at this situation. The course of the disease, as observed here, is generally chronic, and 
may continue for months before the slough separates or the patient dies from long-continued 
irritation or septicsemia. The practice of making incisions to relieve tension. Dr. Carmichael 
considered to be of no use : he believes, on the contrary, that it has been injurious, the disease 
rapidly extending after its employment. In cases where amputation was inevitable, his practice 
was to perform it above the line of demarcation. The results in all cases were unfavourable j not 
unfrequently the gangrene recurred in the flaps even after a second amputation. — (XI. 3.) 

During the winter of 1878-79, five total shipwrecks took place on this side of the Shantung 
promontory, but only in one case was there loss of life. In this the crew, consisting of six 
Japanese and five Europeans, were exposed during a whole night on a deserted beach, to a tempera- 
ture of 8° Fahr. with a north-east wind. One of the Japanese fell into a fatal sleep, and the 
survivors were severely frost-bitten. Their limbs exhibited different degrees of injury from the 
frost. Some were swollen, oedematous, and covered with large buU^ filled with serum ; others had 
no appearance whatever of injury, but were perfectly cold and devoid of sensation. In the former, 
the injuries were more superficial; in the latter, the parts were frozen to the bone. Treatment 
consisted in the application of hot poultices ; these hastened the separation of sloughs. Pain 
was relieved by laudanum sprinkled over the poultices, and this decreased the demand for 
narcotics internally. Pain was entirely confined to those milder cases where buUse had formed, 
being quite absent in the more severe injuries. In all, obstinate constipation was present. 
— (XVII. 14.) 

At Ningpo, during the winter of 1873-74, which was a severe one, the Sisters of Charity 

admitted some Chinese into their hospital suffering from frost-bite. In one case both feet had 

dropped off, leaving the lower ends of the tibia and fibula entirely denuded for 

about three inches. In another case, only about one-half of each foot had been 

amputated by nature, and in a third case only the toes suffered. Dr. Mackenzie was ' most 



SYMMETRICAL TUMOURS. — DERMATOLYSIS. — FORMICATION. 199 

anxious to removo the bare bones and useless tissues, but their aversion to the knife of a foreign 
doctor was too great to overcome ; so he was obliged to content himself by applying carbolized 
oil, which soon caused the offensive wounds to cover themselves with healthy granulations. 
—(VII. 2.5.) 

At Swatow, in December, 1876, a severe case of the affection came under notice. The 
sufferer, a Malay, arrived from Chefoo, where he had got frost-bitten. When he was first attacked 
by the cold, he put his feet into hot water. When first seen at Swatow, the left 

(., . ,,.„- .«.T Swatow. 

toot was quite gangrenous, and a line or demarcation forming about two inches 

above the ankle. Amputation was performed, but tetanus set in, and on 31st January, 1877, he 

died.— (XIII. 10.) 

LXI. SYMMETRICAL TUMOURS. 

Dr. Manson gives particulars of a case of what he designates Symmetrical Development of 
Minute Tumours after Suppression of Profuse Sweating : ' From a superficial examination of the 
little tumours behind the ears in the case alluded to, one would be apt to diagnose molluscum 
contagiosum ; but a careful examination revealed the absence of several of the characteristic 
features of that disease ; for example, the central depression and orifice, the tendency to become 
sessile when of any size, and the expressible contents. Those on the hands were very hard, 
and apparently fibrous and solid ; the disease succeeded the suppression of profuse and habitual 
sweating.' According to the experience of Dr. Manson, molluscum contagiosum is not a common 
disease in the neighbourhood of Amoy. He has seen a few cases of it, however, in foreigners and 
in natives.— (XXI. 33.) 

IXII. DERMATOLTSIS. 

Dr. Manson gives particulars in regard to ' Hypertrophic skin-disease,^ for which he has 
difficulty in finding a name. In it there was hypertrophy of all the integuments; the skin hung 
in loose folds; hence he applies to it the term Bermaiolysis. An artificial form of this disease is very 
common at Amoy on the occiputs of old women. It is produced by the manner in which the hair 
is dragged in their peculiar manner of dressing that ornament. He has ' often seen this derma- 
tolysis so considerable, that the whole repulsive-looking mass could be grasped in the hand and 
raised completely away from the cranium.' When such a woman becomes bald, she uses this 
piece of redundant integument as a foundation whereon to glue or otherwise attach her false 
hair, thereby, in the course of a very few years, still further increasing the deformity. — (XXI. 32.) 

LXIII. FORMICATION. 

In his Eeport on Canton for the six months ending March, 1872, Dr. Wong wrote : He has 
seen several cases which merit a detailed description, as he has not noticed any account of the 
affection in question in medical works. The sufferers are attacked with sensations 
like the crawling of ants over different parts of the body ; and in the cases that 
came under his observation, these sensations were mostly on the hands and face, though some- 
times on the arms and back and other parts of the body. They are not felt constantly, but come 
and go, except in aggravated cases, when they are felt every day, or nearly all the time, with 
different degrees of intensity. They are apt to be worse at night, when sometimes they interfere 
with sleep. In mild cases they are felt only occasionally in such electric state of the weather as 



200 EPITOME OF MEDICAL REPORTS. 

commonly produces neuralgic pains, a few days before a fall of rain. In severe cases even a mass 
of clouds overhead is sufficient to bring them on. They are excited by heat and atmospheric 
changes, and by causes working on the mind, as mental anxiety, emotions of fear and anger, and 
even by reading and writing. Cold has a soothing influence, and in cold weather they are not so 
much felt. In all the cases observed, the patients were Chinese; and both sexes appear to be 
equally liable to it. Their general health was good; digestive functions little impaired; their 
sensibility and power of motion unaffected. In some cases they suffered only from these sensa- 
tions; in others, also from muscular twitchings and nervous pains. The native physicians 
recommend a course of tonics in its treatment. The disease does not seem commonly connected 
with any serious lesion of the nervous system, seeing that so many oases of it recover. — (III. 20.) 

LXIV. TINEA IMBEICATA. 

Under the above heading, Dr. Manson, following Dr. Tilbury Fox, includes tinea circinata, 
parasitic eczema, Burmese ringworm, eczema marginatum, Malabar itch, Chinese itch, etc., and 
attributes those varieties of the disease to the influence of diversity of climate, clothing, constitu- 
tion, and part of the body affected. Dr. Manson, however, considers that tinea imbricata and 
tinea circinata are distinct diseases; and he gives cases in illustration of these views; namely, 
one contracted by a native Chinese in the Straits Settlements, the other the ordinary form met 
with in China. He states that in all cases of epiphytic skin disease, bacteria, micrococci, and 
similar low forms of life, abound in and about the epithelial scales. In one experiment, where 
inoculation with the scales of tinea imbricata was performed on the arm of a person affected with 
the disease, no result followed beyond a temporary local irritation. (This is important, as 
indicating the difference there is between a disease communicated naturally, and where an arti- 
ficial method is adopted.) 

A great many cases of this disease are seen at Amoy ; but with one exception all the patients 
have been at one time in the Straits of Malacca, or islands of the Malay Archipelago ; and it was 
there that the disease was acquired. In South Formosa cases occur in all respects similar to 
those from the Straits; and the remark occurs that considerable similarity exists in reo-ard to 
the climate of those places. It would appear that some peculiarity of climate is necessary for the 
ready spread of the disease from person to person, although, when once established in the indivi- 
dual, it flourishes in China as well as in its home, as proved by the results of inoculation. Dr. 
Manson behevea that tinea imbricata is the disease described as Pita or Tokelan itch by Drs. Fox 
and Farquhar, and by Dr. Thin in the Practitioner. If it is identical with the Samoan disease, we 
know that it spreads rapidly enough under suitable circumstances. He considers there is no other 
epiphytic skin disease, with the exception of the fungus-foot of India, with so limited a geo- 
graphical distribution. He considers that tinea imbricata is the connecting link between 
chloasma and tinea circinata ; also that each specific form of tinea is artificially transmitted by 
means of inoculation. — (XVI. Ij 5, 6.) 

Lxv. washerman's itch. 

At Shanghai, April to September, 1873, a peculiar form of skin disease prevails, known as 
washerman's itch, ringworm, or eczema. The ordinary forms of eczema are frequently seen here, 

ShaDgbai. ^""^ ^""^ ^^ amenable to treatment as elsewhere ; but the particular form now alluded 

to proves almost invincible, and the sufferer leads for many months a more or less 

miserable life, according as by temperament he is irritable or the reverse. Especially obstinate when 



washerman's itch. — ITCH. — INTESTINAL WORMS. 201 

it attacks the perineum, groins, and inside of the thighs, where heat and moisture depress the 
vitality of the inflamed skin ; the disease is commonly of short; duration when it attacks the axilla, 
where much the same conditions exist. According to the reporter, washerman's itch may be 
divided into the parasitic and non-parasitic forms, the former demanding the use of parasiticides, 
the latter merely rest and general sedatives. When the disease is neglected until the simple 
erythematous eczema becomes ichorous, or the parasitic affection, while continuing to spread at 
the circumference, leaves behind it an ichorous surface from which no parasitic forms can be 
obtained, the treatment then becomes identical in the two cases. It may be matter of doubt in 
what way the application of ' Goa powder,^ iodine, or caustic potash acts, whether by killing the 
parasite or by setting up inflammation in the cuticle such as is inconsistent with the life of a low 
organism ; but the application is occasionally rapidly successful. Afterwards the resulting 
inflammation yields to soothing applications. When the constitution is broken down, the removal 
of the original cause is followed by the development of an ichorous eczema, in the treatment of 
which, together with suitable local remedies, the internal use of so-called specifics, arsenic, iron, 
or zinc, is required. In the non-parasitic form, if treated early, the application of a weak lead lotion, 
such as Rowland's Kalydor, may be sufficient to arrest the course of the disease. A severe attack 
of eczema having passed by, a tendency to the formation of boils usually persists. These boils may 
be large and solitary — ecthyma in fact — or small and arranged in more or less continuous curves. 
Whether superficial or deep, they are extremely painful, and the lymphatics are constantly impli- 
cated. Their progress is tedious. 

With regard to the eczema, arrow-root poultices are sometimes recommended ; oxide of zinc 
ointment sometimes acts well ; alkaline baths diminish the tendency to secretion ; and the intoler- 
able itching is immediately relieved by 'dabbing' on a delicate lotion of diacetate of lead, com- 
bined with glycerine and rosewater. Notwithstanding that authorities state the disease to be 
non-contagious, the reporter considers that it must be looked upon as being communicable; and, 
moreover, he can cite cases in support of his view. — (VI. 58, 60.) 

LXVI. ITCH. 

The Report on Peking to 30th September, 1873, contains some remarks on ' summer itch ' 
among the Chinese. It is stated that in spring the beggars issue from the Imperial House of 
Refuge covered with itch, psoriasis, boils, and enthetic diseases. From their scanty 
clothing in summer they are readily cured with sulphur ointment. Among the 
lower and middle classes also itch is not uncommon, and from the want of under-garments that 
can be washed, it is difficult of treatment. The Chinese attribute the disease to dampness. They 
are quite unaware of its true nature. — (VI. 14.) 

At Kiukiang, in 1871, out of 288 patients affected with skin diseases, 128 suffered from 

scabies. (II. 61.) Kiukiang. 

At Wenchow, in 1877-78, skin diseases were very general, and of them scabies was the most 
common form — (XV. 41.) Wenohow. 

LXVII. INTESTINAL WORMS. 

According to a Chinese author quoted by Dr. Dudgeon in his Report on Peking to March, 1875, 
'there are nine kinds of worms which infest the human body, namely : 1st, the /m worm, four fen in 
length, and the chief of its class; 2nd, ?/-«, measuring from five to six inches; 3rd, a little 
worm not quite an inch long, with small head and large procreative powers; the 4th is 
called & flesh worm, and resembles rotten apricots; 5th, the lun^ worm, which resembles a silk-worm, 

26 



202 EPITOME OF MEDICAL EEPORTS. 

and the person possessed of it coughs and ultimately begets phthisis; 6fch, 'the stomach worm, 
and resembles a frog ;' 7th, ' the weak or diaphragmatic worm / 8th, the red worm, like raw 
ilesh ; 9th, the jao, small and like the vegetable worm. All those enumerated are stated to 
reside in the stomach and bowels, 'and if a person is of good constitution, no injury from them is 
to be feared ; but if a person be weak, any disease may arise.' The corpse worm lives in a person 
as long as he lives ; when the person dies, it also dies. It is the greatest enemy of man ; it lives 
under the skin, is three inches long, and has ahead and tail. According to one author these worms 
live and flourish and produce with water.and are converted or dissolved by rain vapours. — (IX. 23.) 
At Tientsin, during the year to March, 1880, entozoa of different kinds were frequently met 
. with. The native Chinese suffered most from lumbrici, the foreigners from taenia; 

taenia medio-canellata being the only form met with. — (XIX. 5.) 
At Newchwang, in 1871, according to the Eeport to September of that year, intestinal worms 
NewciawaDg. were the most prevalent of all complaints. — (III. 11.) 
In 1878 tape-worm was prevalent among the Chinese, less so among foreigners. This is ex- 
plained by the circumstance that the former eat pork extensively, the latter beef and mutton. Im- 
pure water is also assigned as a cause. In the treatment, the greatest success has followed the use 
of oil of male fern. In the after-treatment, draughts containing sulphates of magnesia, iron and 
quinine, diluted sulphuric acid in bitter infusion, have been given with advantage each morning; 
a carbonate of iron pill in addition after each meal, The reflex symptoms supposed to indicate 
the presence of tape-worm in the alimentary canal are so numerous that many physicians ignore 
them, and do not treat the disease until portions of the parasite have been voided. The feeling of 
disgust which Europeans experience on becoming aware that they are inhabited by so formid- 
able a creature is the most distressing feature of the case. — (XVII. 9.) 

„ . , . At Chinkiang, in 1877, entozoa of several species were stated to be present, 

lumbrici being the most common. — (XIV 63.) 
At Shanghai, during the six months, October, 1875, to March, 1876, 'one man had an 
Sh h • epileptic seizure, which suggested the presence of tape-worm. A smart turpentine 
purge brought away an unusually perfect specimen of the parasite, and no attack 
has since occurred.' — (XI. 53.) 

In the half-year ending 30th September, 1876, Inmhrici were reported to be very prevalent 
among adults as well as in children. It was stated that ' they flourish doubtless by favour of the 
carelessness which allows unboiled water to be mingled with claret, and imperfectly cleaned 
salad and celery to be brought to table.' — (XII. 3.) 

At Foochow, in 1871, intestinal worms were described as being the great pest at that port. 
So general are they, that when a child is seen fretful and looking ill without any other cause to 
Foociiow account for it, the medical olRoer usually gives a dose of santonine, and in the 
majority of instances lumbrici come away, relief being then obtained from all the 
symptoms. Worms are constantly apt to recur, and a child, after getting well for the time, may 
be as bad as ever in a month or two. The cause of the prevalence of worms among foreign 
children in China is not apparent. If it arose from objectionable articles of food given by the 
amahs, native children ought to suffer still more; but the reporter had not sufficient native 
practice to enable him to decide on this point. By far the most common species of worm here is 
the lumbricus. A good many cases of taenia in adults are met with, and here the extract of 
male fern is generally effectual. — (II. 28.) 

According to the Report to March, 1881, lumbrici were among the most prevalent diseases, 
not only children but adults also being affected by them.— (XXI. 52, 54.) 



riLARIA SANGUINIS HOMINIS. 203 



At Yokotama, tape-worm and round worm are somewhat more frequent than they are in most 
bs of E 
5tence c 
(XY. 68.) 



parts of Europe and America. Bat the parasites are found in that stage of their 
existence during which they are the source of but little danger to their host. — 



LXyill. PILAKIA SANGUINIS HOMINIS. 

In the Eeport on Amoy for the six months to March, 1877, Dr. Manson pursues the con- 
sideration of this subject. — See ante, p. 154. He alludes to the 'probable connection' existing 
between filaria and chyluria and elephantoid disease. He asks, ' Could such lesions 
as this filaria produces in the aorta of the dog give rise to aneurism, were they 
to occur in man V He observes that the prevalence of filaria aortic disease in dogs and the 
frequency of aortic aneurism in man in China is a significant coincidence. He alludes also to the 
occurrence of ' the worm ' in the eye of the horse. 

Of 190 persons whose blood was examined by Dr. Manson, the presence of filaria was 
detected in 15, equal to about 8 per cent. He considers that the ordinary measurements of 
the parasite are one-ninetieth of an inch in length by one three-thousandth of an inch in breadth. 
He gives details of various diseases, elephantiasis and lymph scrotum among them, and observes 
that in some instances hsematozoa were present, in others not. He adds, however, that ' the 
filaria sanguinis hominis may be present in the blood, and yet the host be in good health, and 
exhibit no other morbid phenomenon ; also, that in the same person it may be present at one time 
and absent at another.' — (XIII. 31.) See also Pilaeia in Dogs. 

Dr. Manson, in his Report to September, 1877, continued his remarks on filaria. He had 
examined 670 individuals of the general population of Amoy, and in that number detected the 
presence of the filaria in 62, equal to 9'25 per cent.; this also apparently exclusive of those who 
suffered from definite forms of what he terms filaria disease, namely elephantiasis, varicose 
lymphatic glands, and lymph scrotum. Adverting to the cases in which 'embryos' of the filaria 
were not detected, the remark occurs that as most of these were examined only once, ' it might 
so happen that just at the time of examination the embryos were absent.'' (If so, their where- 
abouts has not been suggested.) According to this reporter the liability to filaria rises in 
relation to the age of the subject of the parasite, from 1 in 17'5 in youth to 1 in 3 in old age. 
It does not appear that this rate of liability is affected by sex. 

He considers that elephantiasis and allied diseases are much more frequently associated with 
filaria than with any other morbid condition. He, however, would make a correction for 
' temporary absence ' of the parasite, although he observes that ' the propriety of this is question- 
able.' He considers that ' mere coincidence ' will not account for the association of the parasite 
and the disease ; they can only stand to each other in the relation of cause and consequence. 
Yet ' the disease, so to speak, is only an accident, though a very frequent one, in the history 
of the parasite.' Dr. Manson alludes to ' wandering filaria that have lost their way.' He 
considers that they do more injury than those that reach and breed in 'their proper habitat,' 
and as an example he instances the eye worm of the horse. He accounts for the absence of 
' embryos ' of filaria in certain cases of elephantiasis, by supposing that the death of the parent 
filaria occurred early in that disease. Hydrocele is considered to be a disease frequently 
associated with heematozoa; according to Dr. Manson ' the prevalence of that affection in hot 
climates may be thus accounted for.' — (XIV. 1, 5, 6, 7.) 

With regard to the filaria hominis, Dr. Manson states that in cases where embryo filarias are 
not in great abundance in the blood, they often disappear completely for a time, to reappear after 

26—2 



204 EPITOME OF MEDICAL REPORTS. 

the lapse of a few days or weeks. This disappearance he attributes to their disintegration ; he 
moreover states that they are voided in the excretions and secretions, and that they have been 
found in the urine and tears. He then writes that ' man may swallow this hypothetic animal.' 
He observes that 'it occurred to him' that the mosquito which fed on the blood might be the seat 
of changes in the development of the filaria found in the blood. Having ' experimented ' on 
mosquitoes that had fed on human blood, he found that his ' idea was correct.^ It appears, 
however, that it is only the female mosquito that feeds upon blood, the proboscis of the male being 
unsuited for this purpose. A large number of 'experiments' and details are then given, but 
which are omitted in this place. Among the conclusions drawn from the observations made, 
were — 1st, that filaria and elephantoid diseases- were related to each other as cause and effect ; 
2nd, that such disease is endemic only where the mosquito flourishes. — (XIV. 9.) 

With regard to the occurrence of filaria disease at Amoy, 1879, the reporter quotes various 
opinions in favour of and adverse to the theory of the relation of filaria to lymph scrotum and 
elephantiasis. He then enters into details with a view to support his belief that the parasite and 
disease are related to each other as above stated. He observed six cases of this affection, all of 
which had this feature in common^ that in them there was enlargement of the inguinal glands. In 
the clear lymph obtained from those glands there were abundance of filariee, although none in blood 
obtained from the finger. In some instances lymph scrotum was associated with elephantiasis ; 
in others not so. In cases of elephantiasis attended by inflammation of the leg, the accompanying 
pyrexia was designated elephantoid fever ; also transient iever. Then follow remarks as to whether 
filariee are oviparous or viviparous ; as to the specific alliances between those entozoa and those 
found in the corvus torqnatus, the Goura coronata, and the dog. The reporter had examined a 
number of patients ' with the result of finding that unless there is some distui-bance, as fever, 
interfering with the regular physiological rhythm of the body, filaria embryos invariably begin to 
appear in the circulation at sunset, their numbers gradually increase till about midnight ; during 
early morning they become fewer by degrees, and by nine or ten o'clock in the forenoon it is a 
very rare thing to find one in the blood.^ This diurnal periodicity is accounted for after this 
manner : ' The nocturnal habits of filaria sanguinis hominis are adapted to the nocturnal habits of 
the mosquito, its intermediary host ;' and then follows a dissertation, more or less theoretical, in 
regard to the stages through which the filaria embryo is stated to pass. The present object is 
sufficiently obtained by simply transcribing the above particulars. — (XVIII. 31.) 

In the Report on Amoy to September, 1880, there is a continuation of previous remarks on 
filaria sanguinis hominis. The belief is expressed that the habitat of the parent filaria has been 
discovered by the observer. As illustrative cases, details are given of one of lymph scrotum, in 
which the filaria was discovered in the lymph obtained therefrom, but not in the blood of the 
person affected. A portion of the scrotum having been removed and placed in a vessel, the 
reporter ' saw wriggling on it very vigorously a long and slender worm of a catgut opaline look, 
the thickness of a medium-sized horse-hair. One end of the worm was free to the extent of 
two inches, the other entered the cut end of a " lymphatic." ' The worm appeared to be working 
back again into the scrotum. The portion observed was the head end of a female. — (XX 14.) 

At Foochow, in the six months ending March, 1881, Dr. Eennie, with a view to determine 

the frequency of occurrence of ' filaria sanguinis hominis' among hospital patients, examined 

microscopically the blood of 182 patients. The examination took place at 9 p.m.; 

and in 25 instances ' embryos' of thefilariee were found in the blood. The patients 

in these cases were affected with various diseases. They came from different parts of the city and 

of the neighbouring country. — (XXI. 56.) 



FILARIA SANGUINIS HOMINIS. 205 

la August, 1870, Dr. Myers took over from Dr. P. Manson charge of the native hospital at 
Takow, and from that time continued investigations on the subject of filaria sanguinis hominis, 
previously conducted by Dr. Manson. As a result of his inquiries, Dr. Myers „ 
was ' led to think that this state of blood-infection is not common to, nor favoured 
by, residence in Formosa.' He noted in regard to that island, also, ' the almost total absence of 
those diseases which Dr. Manson has proved to be dependent on parasitic obstruction, such as 
elephantiasis and lymph scrotum.^ He is ' strongly inclined to think that filaria sanguinis 
hominis does not exist in the blood of the natives of this place.' He observes that the only three 
persons ia whom filaria-infected blood was found had come from Amoy; and that the only 
person heard of as affected with elephantiasis scroti traces his disease to residence on the main- 
land. Dr. Myers assumes ' that all now take for granted the fact that the mosqaito plays an 
essential part in completing the cycle of genesis of the parasite.' He details a series of experi- 
ments on monkeys, in the course of which these creatures were made to drink water containing larvae 
of mosquitoes, and their blood was subsequently tested for filarise. He notices the strong antipathy 
these animals have to drinking water that appears impure, or in which there are objects in 
motion. The subsequent examination of the blood was without result, a circumstance accounted 
for thus : ' I have no doubt that in all the cases which came under notice the mosquito was an 
inhospitable host, digesting where it should have nurtured.' 

Dr. Myers made a series of observations on a native of Amoy in view to note the periods of 
appearance and disappearance of the embryos of filaria from the blood of infected persons : ' The 
embryos appeared regularly between 6 and 8 p.m. By 6'45 p.m. they had begun to appear 
regularly; but not until 7'15 p.m. had they become numerous. By midnight they seemed to 
have attained their maximum • decrease then set in, and they appeared to retire between 6 and 
8 a.m.' Thus, during the twelve hours they disport themselves, their liberators are in active 
search for food. Temperature bears no very marked relation to the number or activity of the 
embryos; still, some influence seems shadowed forth. Dr. Myers wrote: 'From what Dr. P. 
Manson has written, I gather that he is inclined to think the embryos do not periodically dissolve 
in the blood, but that they probably congregate in some organ (possibly the lungs), and there 
remain until the time arrives for their wanderings and withdrawal by mosquitoes.' In favour of 
this view he gives the results of post-mortem examinations of dogs, ' in the lungs of which he 
finds a great congregation of embryos.' He owns that he is 'not as much influenced by this as 
Dr. Manson would seem to be.' He queries the conclusion Dr. Manson draws from certain data, 
as to his mind they do not follow the premisses. As to the manner of the periodical disappear- 
ance of the embryos from the blood, he writes — ' all must be more or less surmise.' H the 
embryo die every 24 hours in the host, why do they live so much longer when liberated ? As 
to the cause of their disappearance. Dr. Myers ventures no more than a surmise. When To- Ah, 
the man experimented upon, was taking quinine (and so it was with the other two patients), he 
noticed that the embryos were less lively and healthy-looking than when he was not taking that 
drug. Dr. Myers considers it ' tolerably certain that the locale of the mature worm is in the 
lymphatic system, and generally in the more superficial glands; that with dogs, though worms are 
found in other parts of the vascular system, still the greater number reside in the heart ; yet in 
man, the home of the parasite appears to be less desperately localized.' — (XXI. 11-23.) 

In the 22nd number of the ' Customs' Medical Reports/ namely, to September, 1881, Dr. 
Manson gives extracts from a letter addressed by him to Dr. Cobbold, on the subject of filaria. 
With regard to the 'periodicity' of the parasites he writes: 'Whatever the cause may be, it 
certainly operates through the body, the medium in which the parasites are;' but he 'very much 



206 EPITOME OF MEDICAL REPORTS. 

inclines to think that, tKough operating through the body, it ia placed outside of it. Of one 
thing we may be quite certain, that, from the fact of the periodicity being one of 24 hours, 
its remote cause is the rising and setting of the sun. But, continues the paper, ' the periodicity 
bears no relation whatever to the hours of sunshine, cloud, or rain.' Having alluded to the 
periods of terrestrial magnetic maximum and minimum intensity, he observes that ' these hours 
correspond very closely with those of commencing rest and activity of the filaria in the normal 
state of the body ; but there is no proof whatever that there is any cause-and- effect relation 
between these two phenomena.' — (XXII. 63, 64.) 

In the 23rd number of the series of Eeports, Dr. Manson refers to what he had previously 
written in regard to ' filarial periodicity ' being ' an adaptation of the habits of the filaria to 
those of the mosquito.' He adds that ' the particular force or mechanism that operates on the 
embryo parasite, causing it to appear in the blood normally only at certain hours, has yet to be 
ascertained.' In reference to terrestrial magnetism in relation to periodicity,' the progress of 
discovery has rendered a connection between the two so extremely improbable that he has not 
considered it worth while to pursue investigation in this direction any longer. ' Dr. Manson 
alludes to a communication in the Lancet of 27th August, 1881, by Dr. Mackenzie, by which the 
circumstance appears that ' the same periodicity was observed by the parasites as had been 
described as occurring in China.' If the patient slept during the day and kept awake during 
the night, periodicity was inverted; therefore, something bound up with the sleeping and waking 
states has clearly a powerful influence on the parasite or its young. When experiments and 
facts have been multiplied we may be able to say precisely what is the cause of filarial 
periodicity. At present, facts are wanting. 

Fortunately, there is abundant evidence that filaria sanguinis hominis does not always, or even 
generally, give rise to disease. But the evidence is equally strong that at times the presence of 
the parasite entails grave disease; that this disease is sometimes in one organ, sometimes in 
another. Why should the parasite give rise to disease ia one man and not in another ? and why 
should one organ suffer in one subject, another organ in a second, another in a third, and so on ? 

With regard to the relation between filaria and elephantoid diseases. Dr. Manson believes 
that the true pathology of the latter is the following, namely: 1. Parent filaria in a distal 
lymphatic; 2. Premature expulsion of ova; 3. Embolism of lymphatic glands by ova; 4. Stasis 
of lymph ; 5. Regurgitation of lymph and partial compensation by anastomosis ; 6. Renewed or 
continued premature expulsion of ova; 7. Further embolism of glands. 

Dr. Myers, in his Report, October, 1881, to March, 1882, regrets that he is unable to furnish 
further particulars regarding the filaria sanguinis hominis, ' on account of the diSiculty he finds 
in getting the filaria-nurturing mosquito brought from Amoy to live long enough to enable him 
to carry on his experiments on monkeys. (On the subject of filaria sanguinis hominis, see also 
British Medical Journal, April 7th, 1883).— (XXIII. 3, 4, 7, 1 1, 14, 20.) 

LXIX. DISTOMA EINGEEI. 

In the Report on Amoy, April to September, 1880, there is a description of a ' new ' parasite 

named after its discoverer, Distoma Bingeri. It was found lying in the lung-tissue of a 

Portuguese who died of thoracic aneurism. ' Whilst alive, a number of young 

(microscopic) distomse escaped from an opening in the body. There were some 

small deposits of tubercles, but no cavities.' Some illustrations of the object occur facing page 10 

of the Report. Similar ' parasites ' were found in the sputa of a man affected with eczema. With 



DISTOMA RINGERr. — TRICHINA — GOLD-POISONING. 207 

reference to this discovery, however, the observation occurs that ' we are as yet not in a position 
to say much about the pathological significance of this parasite/ — (XX. 10.) 

With reference to this subject, Dr. Manson contributes further remarks in the 22nd issue of 
the 'Customs' Medical Reports.' He observes that this 'new parasite,' occurring in Tamsui, 
Formosa, was associated with a peculiar form of recurring haemoptysis. Professor Baelz of Tokio, 
writing in the Lancet of 2nd October, 1880, states that it is not uncommon in Japan. The 
geographical distribution of the parasite is peculiar, if it be the case, as seems probable, that it 
is rare, or entirely absent, on the mainland of China. Dr. Baelz considers that it exists through- 
out Japan ; and inasmuch as the geological composition of Japan and Formosa is volcanic, the 
circumstance is suggested in explanation of the presence of the parasite in both those localities. 
' Our knowledge of the history of the ovum indicates the direction which effort at prevention 
should take. But our knowledge in this instance is a little in advance of any prevention we may 
look for in a Formosan.^ — (XXII. 55.) 



LXX. TRICHINA. 

At Peking, according to the Report to September, 1871, if filthy feeding of pigs induced 
trichinje, the most disastrous effects would be seen in China, for pig life here, as „ , . 

.... Peking. 

elsewhere, is simply revolting. — (II. 79.) No case of trichinosis is recorded. 

In the Report on Shanghai to September, 1880, the observation occurs that, ' when one con- 
siders the miscellaneous but always filthy food consumed by pigs in China, and the large extent 
to which pork enters into the diet of the natives j also that not only ordinary . 

cooking, but smoking, pickling, and even saturation with chloride of zinc solution 
are inoperative to destroy the larvae of trichina spiralis, when encapsuled in muscle ' — it is not 
unreasonable to attribute certain cases of sudden death to trichinosis, and yet there is no distinct 
record at this place of a case of that nature having really occurred, although conjectures on this 
point are expressed. — (XX. 34.) 

In that to March, 1881, Dr. P. Manson adverts to the above-quoted observations. He recol- 
lects having seen the combination of pains in the muscles and dropsy, but until reading the 
suggestion of Dr. Jamieson that trichinae spiralis ' might be the cause of this particular combination 
of symptoms, he did not seriously attempt an explanation.' — (XXI. 26.) — See p. 209. 



LXXI. GOLD-POISONING. 

In the Report on Peking from October, 1874, to March, 1875, Dr. Dudgeon states that there 
was one death by gold-poisoning. He writes that this is a favourite mode of committing suicide 
in China. Crude gold is said, in the ' Pen Ts^ao,'' to be poisonous, but prepared gold harmless. 
Another authority denies this, and points to the fact that gold-diggers frequently swallow gold 
without dangerous results ; that, in fact, it is used medicinally, as in palpitation of the heart. We 
know that the salts of gold are strongly poisonous, but it is highly probable that the fatal result 
is owing to local injury rather than absorption. The Chinese, to account for the poisonous pro- 
perties of gold, suppose that serpents left their teeth in the stones where it is found, or that birds 
deposited their dung, which is poisonous, on the stones ; but these suppositions are shown to 
be mere idle guesses. — (IX. 26.) 

At Kiukiang, according to the Report to March, 1877, poisoning by gold-leaf appears to be 



208 EPITOME OF MEDICAL REPORTS. 

seldom practised as a mettod of committing suicide. During a residence of three years, 

^. . Dr. Jardine heard of only one case. He writes : ' Gold-leaf, when it does not 

suffocate, must act simply as an irritant.' He would consider that the rational 

treatment would be the continuous administration of alkalies, with demulcent drinks and emetics. 

How far they might succeed in practice remains to be seen. — (XIII. 6.) 



LXXII. SNAKE. BITE. 

At Hoihow, according to the Report for the half-year ending 30th September, 1881, the 
bamboo-snake (Trigonocephalus ?) is very common, and on account of its green colour is often 
trodden on by natives, who walk through the grass without shoes. Dr. Aldridge 
gives some particulars in regard to two cases of bite by this snake. In the first, 
a man bitten on the ankle was seen twelve hours afterwards. He was then very feverish; pain 
extended up the leg and thigh; oedema extended from the foot to the knee; the skin was tense, 
and the patient was unable to extend the leg. A crucial incision over the bite was made, and fomen- 
tations applied ; the man kept in bed, and in four days he was able to return to work. When first 
bitten, he had taken a large quantity of Chinese wine; to become intoxicated being considered by 
the natives the best line of treatment to be adopted in cases of snake-bite. The second case, like 
the above, was similarly treated, and ended in recovery. — (XXII. 9.) 



LXXIII. THE FLESH OP DISEASED ANIMALS USED AS POOD. 

At Ohefoo, during midwinter of 1875-76, according to Dr. Carmichael, 'the flesh of all 
animals that died of the cattle plague, then raging, was undoubtedly used as 
food by the poor ; but, as far as he could learn, this was followed by no ill 
effects.— (XII. 42.) 

According to the Eeport on Shanghai, from January to March, 1872, medical testimony varies 
as to the presence or absence of danger to man arising from the consumption of the flesh of animals 
slaughtered while suffering from rinderpest. The reporter observes that while no 
one would knowingly eat such meat, yet experience has convinced him that it is 
practically impossible to distinguish the beef taken from the carcases of diseased animals from 
that of those in perfect health; this is even true of those slaughtered in an advanced stage of 
murrain. Therefore, the recommendation was made that an inspection should be made of all 
animals before they were slaughtered. The reporter adds : ' As nobody has actually died in conse- 
quence of eating meat so diseased, it might be rash to assert that the dyscrasia of the blood which 
kills the animal renders the flesh poisonous to human beings; but it is absurd to recommend 
people not to be alarmed, when the meat which supplies their tables may, for anything they know, 
have been cut from an animal dead of a disease which, from the post-mortem appearances, might 
be described as a combination of diphtheria, typhoid fever, and dysentery.' He himself abstains 
from beef.— (III. 72, 79.) 

At Wenchow, 1877-78, the meat sold in the market for Chinese consumption was for the 
most part procured from animals dead by disease, or slaughtered while suffering 
from disease. After a time the meat to be eaten was subjected to regular inspection 
as to its wholesomeness. Pigs are carefully fed and well cared for in sties. — (XV. 40.) 

According to the Report on Poochow for the six months ending March, 1876, Dr. Somerville 



THE FLESH OE DISEASED ANIMALS USED AS FOOD. 209 

wrote : — With regard to the quality of the flesh of diseased animals^ his inquiries were rather 
searching, and with this result : — Such meat he knew to be eaten, not only by the very 
poor natives, but also by those in better circumstances ; and, as he expressed him- 
self, it might be eaten by anyone ' audacious ' enough to do it. It was a case of free choice 
and ' audacity.' Dr. Somerville adds : ' It is some consolation to know that it has not been 
proved, except in rare instances, that the eating of the meat of animals dying from blood-diseases 
has been followed by bad effects.' He excludes meat infested by parasites. — (XI. 45.) 

At Kiukiang, on March 16th, 1872, Dr. Shearer saw some half-dozen members of the foreign 
community who had inadvertently eaten a quantity of measly pork-chops cut from 
a measly pig. The leg, or ham, was cut into, when the muscular substance through- 
out was found to be thickly sprinkled with cysticerci like so many sago-grains. The results to 
the persons who partook of the chops in this instance are unrecorded. — (III. 64.) 

On the subject of trichina spiralis in Chinese pork, Dr. Manson, of Amoy, wrote in 1881 ; ' The 
Ecavengering habits of the native pig must expose it to trichinosis, and many other parasitic affec- 
tions, provided the parasites exist in the country. He made a microscopic 
examination of a large number of carcases in view to its discovery, 73 of them with 
a negative result ; the 74th, however, was extensively trichinosed, enormous masses of encysted 
trichinas in every fragment of muscle. In the 202nd carcase a second specimen of the disease 
was found; but of 225 examined no other example of the parasite was discovered. He has no 
doubt that the flesh of those animals was consumed, also that rats and dogs are eaten daily in 
large Chinese towns. Pork is eaten by the natives thoroughly cooked, and cooked in very small 
pieces.' Cooked as the natives cook it there can be little danger; but a roast leg of pork cooked 
in foreign style would certainly be a most dangerous dish. — (XXI. 26.) — See ante p. 207. 

In the Report on Tamsui and Kelung for the year ending 30fch September, 1875, Dr. Einger 
observes that ' during the summer months a very severe murrain took place among the swine in and 
for miles around that port. Post-mortem examination revealed the lower intestines „ 

■^ , Tamsin. 

highly inflamed and studded with ulcerations.' It was stated that the Chinese con- 
sumed as food many of the dead animals, though he 'never heard of any injurious effects 
resulting therefrom.' — (XL 23.) 

At Swatow, in the half-year to September, 1880, the Chinese ate with impunity the flesh of 
cattle that died of the epizooty then prevailing. — (XX. 24.) Swatow. 

According to the Report on Hoihow for the half-year ending 31st March, 1881, the meat 
of cows that died of the cattle-disease then raging on the island of Hainan was sold 
to and largely eaten by the Chinese, without causing, as far as Dr. Aldridge can 
understand, any injurious effects. Most of the meat sold, however, was from cows slaughtered by 
the farmers soon after they became affected with the disease. — (XXI. 73.) 

LXXIV. MILK OP DISEASED COWS. 

In the Report on Shanghai to 31st March, 1874, the medical officer discusses the subject of 
miZfe-supply at this settlement. He writes that : ' Doubtless the milk obtained in sealed bottles 
from the foreign dairies is above suspicion, so far as intended sophistication is 
concerned ; but the quantity purchased from natives is far in excess of that 
supplied by foreigners, and the stagnant pool nearest to each native dairy subscribes largely to 
the milk-pails taken into the bottling-room.' He quotes the remarks by Mr. Poster of Oneida, 
that milk from cows which inhaled bad odours and emanations from decaying animal or 



210 EPITOME OF MEDICAL REPORTS. 

vegetable matter was unfit for making cteese. — (VII. 35.) It was noticed that when murrain 
was discovered among the cattle at Shanghai, dysentery of marked severity occurred among the 
children there— (III. 85.) 

In the Keport on Shanghai, April to September, 1876, Dr. Jamieson writes: ' By experiments 
on himself and others, Hertwig has proved that the foot-and-mouth disease is conveyed to man 
by milk yielded by animals affected with that malady. Milk loses its infectious properties by 
boiling. In Shanghai, many foreign children are fed on milk derived from all sorts of questionable 
sources — buffaloes and Chinese cows. All milk should therefore be boiled before being used as 
food.'— (XII. 4.) 

With regard to the use of milk of diseased cows, Dr. Jamieson writes thus : 'Most authors 
are silent as to the quality of the milk yielded by cattle during the prevalence of epizooty.' It 
is true that while a diuTinution of milk-secretion is usually an early symptom in nearly all diseases 
of the cow, complete suppression of the secretion accompanies any aggravation or prolongation 
of disease. The source of danger is thus removed by the operation of natural causes. Whether 
milk secreted at the very onset has acquired hurtful properties has not been cleared up. Boiling 
destroys any infective germs it may contain. — (XX. 38.) 

LXXV. POISONING BY FISH AND SHELL-FISH. 

At Ningpo, in 1875-76, several cases of severe purging and vomiting came under notice, 
caused by eating clams and other shell-fish j although alarming at the time, they 

Ningpo. 

were easily managed. — (XI. 27.) 
In his Report on diseases affecting Europeans in Japan, Dr. Simmons discusses this subject. 
Its study has been impeded by the circumstance that cases of severity have generally occurred 
in the less civilized portions of the globe. In those species of fish that are well 
known to be dangerous, the poisonous quality appears to be confined to certain 
individual specimens, or, if more general in its distribution, to certain seasons of the year. In 
Britain, many of the more common fish are known to be unwholesome when ' out of season' — the 
salmon for example ; and any fish, when stale, may produce the usual symptoms caused by 
decomposed animal matter. In Japan, rather alarming though rarely fatal symptoms are some- 
times produced, both in natives and in foreigners, by the use of the katsuo and maguro (bonito and 
albicore). They appear to be injurious only when very stale; but the characteristic symptoms 
due to them, namely, intense congestion of the head and face, are difficult to explain merely on 
the supposition that they are due only to decomposition. It appears, therefore, that in several 
fishes there exists an active poison, sometimes so energetic and fatal in its action as to be com- 
parable to the most deadly agents known to science. The exact nature of this poison, however, is 
not at present understood. 

According to Pappenheim, there are more than forty species of fish which are occasionally 
poisonous ; these occurring in every part of the world, but more especially within the torrid 
zone. Among the tribes that have furnished cases of poisoning are the mackerels (Scomberidee), 
perches (Percidse), the porgies (Sparidae), the herrings (Clupiadae) the weevers (Trachinidse), 
the becuna and barracouda (Sphyrsenidae), and above all, a large number of species of the order 
Plectognathi. Of the six genera belonging to the latter order, five have been found to be 
poisonous ; but in Japan the several species of the genus Tetraodon, known under the general 
title of Fugu, have the most intensely poisonous qualities, so much so that their use has at 
different times been prohibited by law. 



POISONING BY FISH, AND SHELL-FISH. — POISONING BY CASTOR-OIL SEEDS. 211 

In cases oifugu poisoniufr, the characteristic symptoms may come on within half an hour or 
three quarters of an hour. They are at first headache, then quickly great muscular weakness, 
failure of pulse and respiration, depression of temperature, and insensibility. Out of three cases 
recorded, one proved fatal. Dr. Houghton, of Sarawak, mentions thirteen cases of poisoning by 
Tetraodou hystrix (a fish closely allied to the Japanese /wgrw., and perhaps identical with one species), 
from eating which the symptoms were similar to those above recorded, taken from the description 
by Dr. Goertz, of Yokohama. In all the cases mentioned, both at Yokohama and Sarawak, the 
symptoms of poisoning occurred only in persons who had partaken of the roe of the fish. Cases 
of a serious character have even been reported as due to the roe of several of the more common 
European fish, particularly the pike and barbel. Next to the roe of the tetraodon, the liver of that 
fish appears to be the most poisonous part. Deaths within seventeen minutes after partaking of 
it are reported from the Cape of Good Hope. According to Kaempfer, the Japanese believe that 
the fugu may be eaten with safety, provided the head, the bones, and contents of the abdomen 
are removed. Somewhat strange also is the circumstance that, notwithstanding the dangers 
which accompany the consumption of the fugu, and that legal punishment is attached to the act, 
the natives of Japan persist in consuming it. 

Poisonous Grustacece and Mollusea. — The effects caused by these are rarely so grave as those that 
are due to poisonous fish. The symptoms produced are those of irritant poisons ; and in the 
severer cases, depression of the nervous system analogous to that from fugu, as above described 
The exact nature of the poisonous quality in these lower tribes has not been ascertained. It has 
been assigned to copper, but chemical analysis has failed to detect the presence of that metal. 
According to views expi-essed by Orfila and Dr. Beunie, it is due to the circumstance of the 
oysters feeding upon the spawn of star-fishes, in itself an irritant poison. It. is said that oysters 
taken from the canals in Yokohama and Tokio, or from the immediate neighbourhood of those 
conduits, are more frequently injurious than are those taken from purer and more open water. 
The canals in question are little more than open sewers. — {XV. 64-66.) 



LXXVI. POISONING BY CASTOE-OIL SEEDS. 

In the Report on Newchwang to March, 1879, Dr. Watson gives details of a case of poisoning 
by a minute dose of the seed of the Rieinus communis. The symptoms were those of cholera, 
the result of eating one seed in mistake for a bean. Five minutes after the patient 

1 • 11- ••11 !•! 11 NewchwaDg. 

had done so, he experienced a burning sensation in the throat, which extended 
throughout the entire alimentary canal. A few minutes later severe vomiting and diarrhoea set in, 
and rapidly reduced him to a very prostrate condition. Steam inhalations, with morphia and 
brandy internally, and mustard-poultices, gave relief within an hour or so ; but for two or three 
days he was weak, his digestion deranged, and he complained of dull aching, which extended from 
one end of the bowel to the other. The interesting features of this case are the smallness of the 
dose which produced such severe symptoms, and the rapidity with which the poison acted on a 
strong man in perfect health. In Taylor's ' Principles and Practice of Medical Jurisprudence ' 
(2nd edit. vol. i., p. 328), it is reported that of three sisters poisoned by castor-oil seeds, they took 
respectively 'about twenty,' 'four or five,' and 'two' seeds. The first died, the other two recovered ; 
but in none of the cases did the symptoms of poisoning occur until five hours after eating the 
seeds.— (XYII. 11.) 

27—2 



212 EPITOME OF MEDICAL REPORTS. 

LXXYII. POISONING BY OPIUM. 

In tte Report on Peking, April to September, 1873, the medical officer states that attempts at 
suicide by opium are frequently made by the Chinese. In allusion to cases of this nature reported 
at Shanghai, in which airofine as an antidote was successfully used in ten out of 
'^ ™^' sixteen cases, the reporter alludes to an article in the Medical Times avd Gazette, 
(21st September, 1872, p. 342), in which atropine is condemned; and Dr. Harley's work, 'The 
Old Vegetable Neurotics ' (p. 300) is quoted as showing that the effect of atropine is to increase 
the cerebral and angesthetic effects of opium. Dr. Harley considers that the evidence of antago- 
nism between belladonna and opium is inconclusive ; that belladonna intensifies and prolongs the 
effect of opium.— (VI. 17.) 

Strychnine has been stated to be a certain antidote to opium in horses and dogs. In 
the Medical Times and Gazette, as quoted above, a case is recorded of atropine-poisoning 
by subcutaneous injection being successfully treated by muriate of morphia. In the cases 
reported, the quantity of opium taken was from 75 to 350 grains, usually of the paste procured 
for opium-smoking. The remedies employed by Dr. Dudgeon were emetics, draughts of strong 
coffee or tea, enemata of coffee or tea, vigorous rousing and walking, and, in the worst cases, 
chafing the extremities. In four cases he injected atropine subcutaneously ; of these, two 
recovered and two died. In six more cases, all lived. How far the recoveries were due to 
atropine, and to nothing else, is not stated ; rather, doubts on the subject are expressed. At 
Peking opium-poisoning is very rare — so much so, that in nine years only one case was related. 
At the date of the Report under notice, however, three cases occurred, of which two died and one 
recovered. The Chinese believe that a person poisoned by opium may be resuscitated at any 
time within seven days. — (VI. 18.) 

In the Report on Tientsin to 30th September, 1874, the medical officer mentions two cases of 
opium-poisoning, in each of which, after the usual remedies, including the subcutaneous injection 
. of atropine, had failed, the injection of iced water into the stomach by the stomach- 

pump saved the patients, although both were given up, and respiration had almost 
ceased.— (VIII. 40.) 

Dr. Myers, in his Report on Chefoo for the year ending 31st March, 1872, writes: The 
antagonism between opium and belladonna was pointed out by Prosper Alpin 300 years ago; but 
it is only since 1 843 that any large number of instances have been brought forward 
in proof of the virtues of atropine as an antidote to opium. Dr. Myers has found 
injections containing one-third to half a grain of the alkaloid the most satisfactory. According to a 
foot-note, the credit of this method of treatment rests with Dr. Wilson of Philadelphia {Medical 
and Surgical Reporter for November, 1868, and Lancet, 3rd April, 1869). In his case a solution 
of J grain of the alkaloid was injected successfully when the patient was obviously at the point 
of death.— (III. 39.) 

In February, 1878, a case of opium-poisoning occurred in which the quantity of opium taken 
slightly exceeded 20 grains. The patient, a Chinaman, when seen nine hours afterwards, was 
profoundly comatose. Cold effusions to the head and chest having failed to rouse him, a third 
of a grain of atropia was injected hypodermically, but this treatment was also unsuccessful. 
He died shortly afterwards. — (XV. 18.) 

At Kiukiang, in 1871, a Chinaman, aged 24, swallowed 4 mace, or about half an ounce 

avoirdupois, of crude opium with a view to suicide. Twelve hours afterwards he 

was found awake, able to sit up in bed, speak, and swallow some hot water and 

mustard, There was no undue contraction of the pupils. He recovered without emesis, or any 



POISONING BY OPIUM. 213 

means whatever having been employed to nullify the effects of the poison. The man was not, 
and never had been, an opium-smoker. There is no way of accounting for his recovery except 
on the supposition of personal idiosyncrasy or constitutional insensibility to the action of opium. 
In a foot-note it is stated that Taylor ('Guy's Hospital Reports,' October, 1850, p. 220) relates a 
case in which 5 ounces of tincture of opium was taken without producing sleep, and the patient 
recovered. The corresponding quantity of opium would have been 3 drachms. — (II. 63.) 

In the Eeport on that place for the half-year ending 30th June, 1872, there occurs the record 
of a case of poisoning by opium in which recovery was considered to have been due to the 
administration of strychnia. The patient, a Chinese, aged 28, was in the habit of smoking a 
mace of prepared opium daily. On account of a family quarrel he swallowed half a tael weight 
of native crude opium, equal to 6 drachms avoirdupois. In the treatment, emetics of sulphate 
of zinc, the application of the stomach-pump, and strong coffee were used ; and he was kept walking 
about between two coolies. Subsequently, four doses, each containing one-eighth of a grain of 
strychnine, were administered at intervals of half an hour and upwards; and recovery taking 
place, it was attributed to the strychnine. — (III. 63.) 

In that to March, 1875, the record occurs of one case of poisoning by opium successfully treated 
as follows : The patient was a woman who had thus attempted suicide. When first seen she was in a 
semi-comatose condition from which she could not be roused, except to a partial extent by repeated 
flagellation. As her friends disapproved of the application of the stomach-pump, an emetic of 
sulphate of zinc was administered with difficulty ; sinapisms were applied to the calves of the 
legs, iced water dashed in her face, coffee administered (after a time), and men employed to drag 
her about. After persisting in these means for three hours, she was permitted to be taken to 
her house, where she was still kept in movement for some further time. She made a complete 
recovery. — (IX. 4.) 

During the year ending 31st March, 1877, four cases of opium-poisoning were reported. Of 
these, three recovered and one died. In the latter, all ordinary means of treatment having 
failed, -^xi grain of atropine was injected subcutaneously. ' This dilated the pupils for a few 
minutes, but the patient never rallied, and died seventeen hours after the fatal dose.' — (XIII. 6.) 

At Shanghai, during the six months, October, 1874, to March, 1875, several cases of opium- 
poisoning came under notice. An emetic followed by strong coffee sufficed to ensure recovery in 
some cases ; in others, the patient when seen was moribund, or actually dead. A ^ 
case is related of a man who mixed a quantity of opium, variously estimated at from "" ""^ "'■ 
3 to 6 mace, with a cup of tea, and drank the mixture. Three hours afterwards he was being 
dragged up and down the waiting-room, being quite unable to walk. An emetic of sulphate of 
zinc had acted, but he was then unable to swallow ; the surface was pale, cold, and covered with 
perspiration; he had an involuntary action of the bowels ; the pupils contracted and insensible to 
light; pulse 40, respiration 11 per minute. While a solution of strychnine was being prepared, 
the patient was placed in a chair, his stomach washed out by a stream of cold water passed con- 
tinuously through it ; 20 minims of the liquor strychnia B.P. (grs, \) were injected subcu- 
taneously. Within fifteen minutes he was able to swallow some strong tea ; shortly afterwards he 
vomited freely ; the pupils dilated, and were sensitive to light; he was allowed to sleep, and 
recovered. — (IX. 19.) 

At Wenchow, according to the Eeport to March, 1878, opium-poisoning cases at certain 
periods of the year are common. On the occasions where the aid of the medical 
officer has been sought, the subjects have been generally insensible. Dr. Myera 
has been able by means of atropine and strychnine, ' after washing out the stomach with cold 



214 EPITOME OF MEDICAL KEPORTS. 

water/ to resuscitate the greater number of those treated. The Chinese remedies most in vogue 
here are : first, the contents of the adjacent urinal or fluid from a latrine ; next, the warm blood 
as it spurts from the recently incised throat of a sheep, goat, or fowl. In ignorance of this last 
mode of procedure, the first few discharges from the stomach-pump are apt to cause alarm. Un- 
accountable as it may appear, the above would-be emetics generally fail to bring about the 
desired result. — (XV. 41.) 



LXXTIII. OPIUM-SMOKING. 

At Peking, in 1871, opium was described as 'of all our luxuries tbe surest destroyer of health, 

prosperity, position and life.' Among the physical evils whicb follow indulgence in it are 

dyspepsia, inveterate constipation, diarrhoea, dysentery, and spermatorrhoea on 

its withdrawal. The native-grown opium is milder than the Indian ; it is also more 

fragrant, less injurious, and cheaper than the latter. — (II. 80.) 

In the Report to September, 1872, the statement occurs that opium-smokers when imprisoned, 
and thus deprived of opium, suffer greatly in consequence, and that many of them are carried off 
by diarrhoea and dysentery. — (IV. 32.) In that to September, 1873, Dr. Dudgeon writes on the 
supposed antagonism between opium and ague. Among ague patients he has seen not a few who 
have been opium-smokers. He has not been able to trace any antagonistic effect between opium 
and malaria, so as to enable him to pronounce with authority on the subject. At the commence- 
ment of the opium trade at Canton, ofiicials, from the north especially, were in the habit of par- 
taking of the drug to prevent the depressing effects of the climate, and ague, with which they 
were attacked, or to which they were rendered liable. The Chinese then, as now also to some 
extent, were anxious to find some excuse for indulgence in the illegal drug. Doubtless the benefit 
they derive from the soporific was not in warding off ague or neutralizing the poison of malaria 
but simply as soothing the system and blunting sensibility. China as a whole is a mountainous 
country, ague is almost unknown in many provinces ; opium-smoking is general everywhere, and 
smokers are attacked with intermittent fever. — (VI. 8.) 

At Newchwang, in 1871, the Report states that 'opium-smoking is on the increase, although 

it is far from general.'' In regard to it, the medical officer writes : ' Its consequences are so 

disastrous in many cases as to make all earnest men regret its increasinar hold upon 

Newchwang. . . , ° or 

the people of this great empire. — (III. 13.) Dr. Watson writes in the Report to 
September, 1876: — 'He had under his treatment a considerable number of Chinese porters, 
compradors, and small traders, who smoked opium more or less. The practice did not appear 
to injure the health in more than 10 per cent, of those addicted to it ; nor, except in that 10 per 
cent., was the quantity of the drug consumed increased from year to year. With reo'ard to the 
remaining 90 per cent., if the drug did not appear to do them any good, neither did it seem to 
manifestly injure them. Of the 10 per cent, who took opium in quantities to affect health, the 
effects in them were loss of appetite, constant diarrhoea, impaired physical and mental energy,' etc. 
Dr. Watson observes that opium, except as a medicine, is never necessary ; that the tendency of 
those who use the drug is to increase the dose; and that as regards both opium and alcohol, it is 
difficult to say which has the more debasing effect when taken in excess. His own conclusion is, 
'that foreigners have generally exaggerated the amount of evil said to follow the use of opium;' 
but he has no doubt in his own mind 'that opium-smoking is unmistakably an evil.'— (Xli. 38.) 
At Kiukiang, in 1871, of 197 opium-smokers, 27 used about 5r> daily; 54, 3i. ; 38, 5ii3 ; 



OPIUM-SMOKING. 215 

41^ 5^]-; 18, Siij.; 8, 3iv. ; 7, 5v. j and 4, 5vj. The period during which they had thus smoked 
varied from 10^ 17, 20 to 30 years. The whole of the above 197 had applied . -g-j^,^;^^ 
for medicine to break them of the habit. It is calculated that one-tenth of the 
inhabitants are opium-smokers. The use of the drug has the reputation, and usually does act as 
a prophylactic against malarial fevers. Two opium-smokers having been attacked with tertian 
ague, which passed into the continuous or remittent type, their cases were looked upon as excep- 
tional. In several persons who had given up the habit, agues occurred with or without diarrhoea. 
Dr. Shearer further says that of confirmed opium-smokers who appeared to have been ' cured' of 
the craving and habit, many relapsed into their old indulgence when the state of their finances im- 
proved. Poverty, and consequent inability to purchase the drug, was the general excuse pleaded 
for coming to see him. Some reduced the quantity used from three to four mace to one, and there 
stopped. A great deal of physical distress is endured by many on laying aside the pipe. 
Diarrhoea and bloody flux, abdominal pain, gnawing and uneasiness, wrenching pains in the 
joints and limbs, insomnia and anorexia, are some of the symptoms complained of. Within equal 
periods he has seen nearly three times as many opium-smokers in Kiukiang as in Hankow. — • 
(II. 62.) 

In the Report on Hankow to September, 1874, some remarks occur on the same subject. 
The experience of Dr. Reid amounted to over 500 cases of opium-smoking. In every instance 
the applicants for medical advice had lost their means of subsistence through „ , 

. ° Hankow. 

the use or this drug • but nine-tenths of them had no idea of finally relinquish- 
ing the pipe. Their object in coming was merely to obtain a remedy to appease their present 
craving and restore their strength, so as to enable them to resume their duties and earn wages 
to be again expended iu opium. Among dispensary patients, the chief patrons of the drug are 
found among the half-idle shopkeepers and yam^n attendants. Those who have to earn their 
bread by the sweat of their brow have generally a wholesome dread of the habit. None of the 
hard-worked coolies can take it with impunity in what may be considered moderate doses by 
a regular smoker, namely one to two t'sien (55 to 110 grains) daily. Ansemia, emaciation, 
loss of appetite for good nourishment are sure to follow, and the accompanying loss of physical 
strength soon entails beggary on the labourer and his family. Even while work can be carried on, 
the expense of the indulgence is ruinous, as a certain sum must be daily devoted to the stimulant. 
While a powerful coolie can earn 200 cash daily, it requires nearly 80 to buy his food and a like 
sum for his wife's support if he is married ; there would thus be only 40 cash a day left to provide 
opium, clothes, food for the children, etc. The cost of opium in the divans varies from 50 to 
60 cash per t'sien, and half a t'sien morning and evening is moderate smoking; so that the prac- 
tice can only be indulged in by the labourer if he utilizes in this way the money that ought to be 
expended in food for himself and family. Opium differs from alcoholic indulgence by the abso- 
lute necessity for having a daily quantity. Among the rich, a person has been known to smoke 
an ounce of opium per day; and report states that double that quantity has been taken. In 
divans the foreign opium is mixed with the cheaper native products from YUnan and Szechuen. 
In many country districts the native opium is altogether used, and may be a less injurious article 
than the foreign. The medical officer thus concludes his remarks : ' In alluding to the effects of 
opium-smoking, I do not wish it to be inferred that any injury might arise from its very moderate 
consumption, that is, in quantities of a quarter to half a t'sien daily, as those who came for 
treatment had invariably exceeded that amount.' — (VIII. 45.) 

At Wenchow, when in the period to jMarch, 1878, cholera prevailed, opium-smokers if attacked 
by that disease almost certainly died. — (XV. 41.) In 1881, Dr. Macgowan wrote as follows : 



216 KPITOME UF MKDKJAL KEPOltT.S. 

' Wenchow is an opium-producing and also an opium-importing region. The domestic pro- 
duct is used largely to adulterate Patna opium ; that from Malwa not being so tampered witli. 
Native opium being deficient in alkaloids, produces comparatively transient effects on 
the system.-" Dr. Macgowan states that, under the care of Mr. Douthwaite, the 
Inland Mission established a hospital (at Wenchow) for ophthalmic and opium patients ; that 200 
of the latter were there ' cured ' of their habit, having, on an average, been under treatment four 
weeks each. The average quantity of opium smoked by them was three mace two candareens, 
against four mace, as mentioned by Dr. Dudgeon as the allowance of smokers in Peking. The 
method adopted by Mr. Douthwaite was to withhold from the first the accustomed narcotic, and 
then ' combating the fearful consequences.' Stimulants, astringents, tonics and nourishing diet 
were allowed ; and it is stated that ' a taste for alcohol was never acquired by such patients.' The 
habit of smoking opium having been broken, the man, physically and morally, takes a new departure, 
and gradually recovers manhood in every sense. It is noted, however, that ' he again becomes liable 
to attacks of malarial fever and catarrhs — the narcotic, and a suggestive fact it is, affording him 
immunity from these disorders. Dr. Macgowan observes that ' the cultivation of opium in China 
is favoured by writers of note. In November, 1880, the semi-official Halit-Pau had a cleverly- 
written article defending the culture and use of opium on economic grounds.' — (XXII. 42.) 

In his Report on Takow, ending March 31st, 1881, Dr. Myers writes : ' In Formosa the use of 
opium is indulged in by a great proportion of those of the inhabitants who are either themselves 
immigrants or the descendants of colonists originally from the mainland. Opium- 
smokers are divided into two classes : (1) Those whose social position and wealth 
admit of their giving vent to their passion ; and (2) The majority, who are obliged to work for 
their living, and among whom moderation is the rule. It is not quite fair always to attribute 
to opium-smoking those fearful concomitant evils which are often depicted as its consequences. 
Although excessive smoking may hasten the effects of a general moral depravity, he is inclined 
to think that it is much more often rather a sequence than the cause. Opium-smokers will tell 
you that there is a point, varying with different men, up to which they can go with impunity. 
One old gentleman said he had smoked for thirty years, and at that time seemed to be, as he said, 
tolerably healthy — never exceeded a certain quantity as a maximum on festive occasions ; but that 
there was a minimum sufficient to give him all the satisfaction he required, and this was his 
ordinary allowance.' The highest quantity smoked in a single day, with alleged safety, was five 
mace, while the lowest rate quoted was three mace. But the manner of smoking has to be taken 
into account — the affluent rapidly filling the bowl, and not nearly exhausting the charge, which 
often affords considerable enjoyment to humbler votaries who re-smoke it.' 

In the lowest ranks of life men will be met who have smoked regularly for from ten up to 
twenty or even thirty years, and who show little or no sign of mental or physical degeneration. 
The average quantity smoked is one to two mace per diem. In Southern Formosa there is a class 
of men, including coolies, chair-bearers, and couriers, who daily do a remarkable extent of physical 
work. These have for years taken a certain quantity of opium ; by so doing they assert that 
they attain a greater degree of comfort in performing their work, and Dr. Myers failed to obtain 
evidence to justify him in attributing marked harm to their habit. Among every class of men 
there are those to whom moderation is impossible, and who, in the gratification of their desires, 
will drag themselves and those dependent on them to the lowest misery. This is one of the 
greatest evils connected with alcoholic intemperance; but the result of the experience of Dr. 
Myers in Formosa, and in other parts of China, is that opium-smoking does not, at least up to a 
certain point, provoke excess, as is very often the case with the stimulants commonly indulged in 



OPIUM-SMOKiyG. — ALCOHOLISM. — CHILDBIRTH. 2l7 

by foreigners. He has met with instances in which the effects of opium-smoking were most de- 
plorable. Yet these are few in relation to the number of smokers, and his preconceived pre- 
judices with reference to the universally baneful effects of the drug have been severely shaken. 
Dr. Myers alludes to ' the enormously preponderating amount of opium cultivated in China/ as 
compared to that imported from India. He writes : ' Except at advanced stages of the opium- 
smoker's career, one does not hear of sufferings and other manifestations such as have been so 
graphically depicted by De Quincey, but, at a very early period, the opium-eater begins to com- 
plain and show marked symptoms of the sad effects of his vice. Dr. Myers has had some 
opportunity of contrasting the two effects, and he feels justified in asserting that smoking, as 
compared with eating opium, is as different as the excesses of the ton vivant are from chronic, 
hopeless dipsomania. The smoker may, after a time, reap the painful fruits of his indiscretion — 
with the eater the consequences begin almost directly. 

Adverting to the cure of opium- smoking, Dr. Myers writes: 'Dr. Osgood, of Foochow, was 
the first to commence the cure of opium-smoking by immediate and total deprivation of the drug, 
substituting for it chloral hydrate, which, with tonics, he gave in the form of pill. Dr. Lyall, of 
Swatow, treats all his cases without opium.' But Dr. Myers has ' been led to fear that the 
number of smokers really desirous of being cured is very small, and, too often, application to the 
foreign physician is merely to tide over some temporary inability to procure the drug, to which 
they return as soon as circumstances prove favourable.' One of the greatest obstacles to the 
permanent cure of opium-smoking is fashion — to present the pipe, to join in its participation, has 
become the almost universal sign of courtesy and hospitality. Dr. Myers has had a considerable 
number of applicants for treatment, and many have undoubtedly been cured. But he ' cannot 
recall a single instance where he was sure relapse, after a longer or shorter time, did not take 
place, and it was always the same excuse : " I can't help it. My friends all smoke, and if I do 
not they will leave me, and I shall lose my business, or ' face,' " as the case may be.' 

In the south of Formosa, opium-eating is now becoming very common, and this does not 
supersede the use of the pipe. The consumption of morphia has also greatly increased at 
Taiwan-foo.— (XXI. 60-66.) 

LXXIX. ALCOHOLISM, INCLUDING DELIEIUM TREMENS. 

According to the Report on Yokohama, a marked increase in the percentage of admissions 
from these causes has taken place since 1875. During 1872 to 1874, the annual proportion was 
2-7 per cent, of all admissions; in 1875 to 1877, the ratio had risen to 8 per 
cent. Formerly some of the admissions from alcoholism were entered under the 
head of ' general debility.' Much of the increase, however, is assigned to depression of business, 
which began in 1875.— (XV. 63.) 

LXXX. CHILDBIETH, AND DISEASES CONNECTED THEREWITH. 

At Ohefoo, according to the Report to March, 1873, convalescence after parturition was 
uniformly favourable. Even in cases where the system had been subjected to considerable 
shock and exhaustion, the reporter had no fatal result after labour to reoor^. This 
is mainly due to climatic influences. In two years and a half 51 foreign births 
had taken place with no maternal death, and but one instance, and it embryotomy, of infant 

mortality.— (V. 19-) 

28 



218 EPITOME OF MEDICAL REPORTS. 

At Chinkiang, according to the'Report to MarcTi, 1880, many fatal cases of childbirth have 
been reported, from ignorance in the management on the part of the midwives. 
ChmkiaEg. ^g^Qj,3jjj^ tQ accounts from native sources, labours have extended over four days, 
the delay being caused by cross-birth, and the result, of course, fatal. — (XIX. 8.) 

According to the Report on Kiukiang to March, 1877, skilled assistance in the case of native 
Chinese women during their confinements is never summoned until all hope is fled, and the 
patient is exhausted. Sometimes the foreign medical man is met on his way 
by a messenger announcing the death of the woman; or he finds her in a state of 
collapse, sometimes with sloughing of the vagina from continuous pressure of the foetal head ; or 
that an arm has been presented for sevenfcy-two or eighty hours, the uterus firmly contracted, so 
that evisceration is necessary. Seven illustrative cases are related. In one of these ' spontaneous 
expulsion ' appears to have taken place. — (XIII. 5.) 

In the Report on Hankow to December, 1874, some particulars are given with regard to 
obstetrics among the Chinese. This department of practice for all classes of the community alike 
is entirely in the hands of poor, ignorant old women. Various instances are cited in 
illustration of the gross mismanagement to which cases of difiicult and compli- 
cated parturition are exposed at the hands of such midwives. In one patient the hand and greater 
part of the arm had been extruded for some time, and two old dames were busily engaged in pinch- 
ing and applying salt to it, so as to compel the foetus to withdraw the limb. On their threaten- 
ing to lacerate it with a knife, the father applied to the consular medical oflicer. Having related 
other cases more or less similar. Dr. Reid wrote : ' These few examples are suffi-cient to show the 
boon that awaits the mothers of China, when their attendants shall have the power and oppor- 
tunity of learning something of the principles of obstetrics. They also indicate a high mortality 
from childbirth, and one which may even be greater than in uncivilized countries, from the close 
confinement in which the women are brought up and kept.' — (VIII. 44.) 

In the Report on Shanghai, January to March, 1872, also, the subject of obstetrics among the 

native Chinese is discussed. Among the adult female population, the reporter states that not 

, . one-fifth bear children, while the fertile minority suckle their children for periods 

Shanghai. ' • ■' 

seldom less than two years. Some obscurity, however, hangs over this passage 
as to whether the proportion alluded to refers to married women alone, or to all adult women. 
The Chinese themselves variously estimate the death-rate in childbed at from 5 to 8 per cent, on 
all labours, as against 1'21 per cent, in hospitals in Europe generally. Among Chinese women, 
except in the rare cases when spontaneous evolution takes place, presentations of the arm (say 0'4 
per cent, of all cases) must be fatal to both mother and child. Placenta praavia, foetal hydro- 
cephalus, pelvic tumour, distorted pelvis, insuperable rigidity of the cervix, and many other serious 
complications which demand interference, must terminate in the death of the mother, while the 
probabilities are all against a successful delivery when the labour is powerless, the uterus displaced, 
or the placenta retained. To this list must also be added formidable sequelte, as syncope, 
secondary haemorrhage, puerperal peritonitis, uterine phlebitis, and tetanus, while abortion in the 
early months, with profuse haemorrhage, doubtless results in death in many instances. In reference 
to parturient women, certain superstitious usages among the Chinese are alluded to. ' It is well 
known ' — so it is stated — that there are ten Buddhist hells, one of which is the ' bloody lake.' 
Beneath the surface of this lake all women who die within a month after parturition are supposed to 
be plunged. In order to obtain the release of the sufferers, large sums have to be paid to the priests, 
who, by repeated recitations (of a formula), exert the same power over the purgatorial regions 
which, by means of masses, is exerted by the Romish clergy, Short of actual release, or during 



CHILDBIRTH, AND DISEASES CONNECTED THEREWITH. 219 

the tedious process of accomplishing it, pauses in the torment can be obtained by purchasing the 
privilege of affixing a few hairs cut from the dead woman's head to the inside of a certain bell set 
apart for this purpose. Every time the bell is struck during the progress of the temple ceremonieSj 
the women whose hair is attached to it rise for a moment above the lake, and are allowed to catch 
a breath of air. In 1851, Dr. McCartee visited a temple in the suburbs of Tzu-chi, and found that 
a bell, 5 feet high, which was used for this purpose, was crammed full of hair, while alongside of 
it there stood a firmly packed bale of the same substance, that had recently been removed 
from the inside. This bale was 3| feet high, and nearly 8 feet in circumference. — (III. 
82, 83.) 

In July, 1877, a Chinese woman had been in labour four days. An odour of gangrene per- 
vaded the room, notwithstanding the burning of incense-sticks. The patient was pulseless, the 
abdomen painless ; the vagina and rectum one indescribable cloaca with black, ragged, swollen 
borders ; the perinseum had altogether disappeared; the child's head in the place where the peri- 
neum ought to have been. Two nights previously, a Chinese midwife seeing that the child was 
arrested, tore the parts with her hands, in order to facilitate its exit, but finding no progress 
made by the following morning, she then deserted the case. — (XIV. 45.) 

In March, 1878, a woman, aged 33, in her third pregnancy, fell into labour. Pains con- 
tinued through the first day and night, and became violent on the following day, when towards 
evening two midwives were summoned. On the morning following, the waters having run oS, 
while no progress was made, a third midwife was called, who cut into the child's head, and 
endeavoured to extract it with an iron hook. Failing in this attempt, all three midwives ran away, 
and the woman seems to have been left to die. She was subsequently removed to the GutzlaS 
Hospital, where, on arrival, her condition was desperate ; by means of evisceration of the child, 
delivery was effected ; great deformity of the pelvis was then discovered to exist, but ultimately 
the patient recovered. — (XV. 7.) 

In January, 1879, a woman, aged 25, had been in labour three days when first seen. An 
arm was then found to be presenting, the humerus broken ; the bladder of the patient distended. 
A series of native midwives had in turn maltreated her, and had finally given her up. There were 
no labour-pains. By means of manual interference the medical officer effected delivery, and in 
a few days she quite recovered. — (XVII. 32.) 

In the Eeport on Shanghai, April to September, 1876, Dr. Jamieson notices the comparative 
rarity of post-partum hsemorrhage in parturient women there, as compared with what happens 
in India. But, he says, ' the marked tendency to inertia is worthy of attention.' In 50 cases 
of labour, 5 were abortions earlier than the third month, and 4 miscarriages earlier than the 
sixth month. There was one case of twins, both females. By 41 labours at term there were 
born 23 girls and 19 boys. Of the 42 children born at term, 1 died of trismus on the fifth 
day, and 1 was born dead. In 12 cases of the number the forceps had to be used, namely in 
6 at the brim, and 6 in the pelvis. In 10 of these they had to be applied in default of uterine 
action. Of the 50 cases summarized, 2 were of serious diificulty. 

During the same period a case of puerperal fever occurred. It was of the purely nervous 
form. The patient convalesced well after labour, but on the ninth day, after a severe nervous 
shock, she became delirious, and died in thirty-six hours. — (XII. 9, 7.) 

According to the Report on Wenchow to March, 1881, at the same time that epidemics 
prevailed in the provinces of Kiangsu and northern Chehkiang, puerperal fever 
raged in Soochow. — (XXII. 50.) 

At Foochow, in the Report to Septembei", 1877, Dr. Somerville gave statistics of 38 cases 

28—2 



220 EPITOME OF MBDICAL REPORTS. 

in obstetric practice. Of that number, 4 were abortions before the fourth month. Of the 34 
labours at term, there were born 18 boys and 17 girls, 1 birth being a case of 
twins. Of the whole 38, two mothers died, namely, one from cerebral hasmorrhage 
or embolism on the seventh day, the other from puerperal fever on the seventeenth day. All 
the children of the 34 labours at term were born alive, and of the 35 children, 3 died within a 
few days; these included the twins. Of the 34 labours at term, 33 were head-presentations, 
and 1 a breech-presentation. The forceps were used in 4 ; twice on account of inertia of the 
uterus, once to rectify a mal-position of the head (antero-posterior), and once in a face- 
presentation. In one case there was post-partum hemorrhage or placenta prsevia. In one of 
the abortions there was free bleeding, which necessitated the use of the tampon j in the other 
abortions the loss of blood was very small. — (XIV. 91.) 

At Tamsui, in October, 1877, a death took place from puerperal fever, after a labour which 
. was, as on three previous occasions, perfectly natural. The disease manifested itself 
three days before death ; delirium was of a very mild form ; treatment was power- 
less to do more than afford relief, and the patient died with all the symptoms of blood-poisoning. 
—(XVI. 19.) 

In the Report on Swatow for the half-year ending Slsfc March, 1880, Dr. Scott gives some 

particulars in regard to 80 cases of parturition. In these there were born 82 girls and 

47 boys. Two deaths occurred in the children born at full time, and two in 

Swatow. . •' • • • 1 on 

children born at seven months. The foi-ceps were applied only twice in the 80 
cases. The placenta was retained in 4 cases out of the whole number. Chloroform seemed to 
conduce to inertia of the uterus. Dr. Scott thinks ladies living in the south of China may congratulate 
themselves on the comparatively easy process parturition is there. Added to the above 80 cases he 
notices 5 miscarriages before the third month, and 3 cases of mole-pregnancy. — (XIX. 14.) 

At Canton, in the summer of 1877, a case of miscarriage attended with severe flooding, and 

followed by brain fever, occurred. The ovum having been discharged, a solution of muriate of 

iron injected into the uterus checked the haemorrhage. On the third day fever 

supervened : the head was affected almost from the first ; there was great pain> 

facial twitchings, acuteness of hearing, and spectral illusions. The cold douche, with other means 

of treatment, was employed, and recovery ultimately took place. — (XIV. 58.) 

According to the Report on Hoihow, April to September, 1881, it is considered a most unusual 

thing to hear of a bad midwifery case among the native Chinese in that part of 

the island of Hainan. — (XXII. 9.) 

At Yokohama there is reason to believe that pseudo-menstruation, or a more or less periodical 

recurrence of haemorrhage during pregnancy, is frequent among foreign women. ' Dry labours ' — 

that is, deficiency of the liquor amnii among foreign women — is the rule rather than 

the exception. Puerperal fever, or ' blood-poisoning,' is rare among them. These 

diseases have not been epidemic, although isolated cases, unconnected with each other, have from 

time to time occurred. — (XV. 70.) 

LXXXI. CAPACITY OF EUROPEAN WOMEN TO NUESE THEIK INFANTS. 



At Shanghai, according to the Report to September, 1876, of 41 mothers delivered at full 
, . term, 20 could not nurse their infants at all, 2 nursed them for about three weeks, 

Shanghai. ' 

and 15 for more than three months. — (XIX. 9.) 
According to the Report on Foochow to September, 1872, it is rare to find in China a foreign 



CAPACITY OP EUROPEAN WOMEN TO NURSE THEIR INFANTS. 221 

mother capable of nursing her child, although the attempt is very often made by ladies to do so. 
Native nurses can be obtained from the agricultural population in the neighbourhood. poochow 
This is deemed better for the infant than giving insufEcient nourishment from 
the mother's breast, and supplanting this by ' the bottle.' — (IV. 63.) 

According to the Eeport on Amoy, April to September, 1873, a large proportion of European 
mothers are unable to suckle their children in China. Adverting to this subject, Dr. Somerville 
writes : ' In a natural and primitive state of society, in which artificial means of , 

feeding are unknown, the children of such mothers must inevitably perish ; only 
such children as could be reared by their mothers could survive, and from them the race would 
be continued — a race, the women of which would have the power of suckling their children. 
The European constitution must be altered in this respect before it could flourish here.' — 
(VI. 31.) 

In the Report on Swatow to March, 1880, Dr. Scott observes that of 78 mothers, 41 nursed 
their infants the usual nine months, and some for a longer period, though much against his will ; 
1 had plenty of milk, but preferred to bottle-feed from the commencement; 11 gwatow 
partly nursed, and partly bottle-fed ; 2 nursed for some weeks, and were obliged to 
leave off — 1 because there was no milk, the other on account of abscess of the breast. The 
remaining 23 were unable to nurse at all. From his observations. Dr. Scott is of opinion that 
many foreign women residing in the south of China are unable to nurse, either on account of 
insufiiciency of milk, or of insufiicient nourishment in the milk. He has seen five children 
reared on condensed milk for the first few months, and then on stronger food. — (XIX. 15.) 

At Yokohama, a large number of foreign women are unable to nurse their children, though 
otherwise in good health. It is calciilated that 33 per cent, are in this position. — Japan 
(XV. 70.) 



LXXXII. ARTIFICIAL SECRETION OF MILK. 

In China it is by no means a rare circumstance for a Chinese woman without milk to bring the 
secretion back for the sake of suckling an infant deprived of its own natui'al aliment. In a case 
related by Dr. Mliller, a married woman, aged thirty, who had suckled her own child till the age of 
two years, but whose mammae had been inactive for six years, began in the last week of March to 
bring her milk back. She sXe piptupe stewed with a milk-thistle, as well as her usual rice and fish, 
and applied the infant to the breast constantly. For the first ten days little if any success followed, 
but by May 11th milk was secreted freely. During her period of lactation which followed, mens- 
truation ceased entirely, and she had no leucorrhoea. A second woman, aged forty-five, com- 
menced at the same time as the preceding to encourage the secretion of milk ; she used the same 
means with the addition of the boiled fruit of the tree melon, which in its unripe state has milky 
juice. On May 11th she had a moderate secretion. Her menses diminished in quantity, but did 
not entirely cease. In reference to these two cases, an instance is recorded by Dr. Macartney, of 
Nanking, of similar proceedings, undertaken on a cow, being succeeded by secretion of milk in 
that animal. — (X. 15, 16.) Dr. Barton states that a young bitch had a litter of puppies, which 
she was disposed to ill-use or neglect. Her mother, who had not had pups, or been with a dog 
for more than two years, immediately took charge of them, and drove away the real mother. Her 
teats rapidly enlarged, and within a few days she had a plentiful supply of milk, with which she 
reared the family. — (XI. 56.) 



222 EPITOME OF MEDICAL REPORTS. 



LXXXIII. SICKNESS AND HEALTH OF EDKOFEAN CHILDEEN. 

Adverting to the cases of diarrhoea among children at Kiukiangin 1875-6, Dr. Jardine quoted 
thus from Dr. Eustace Smith : ' During dentition diarrhoea is so common among children that only 
. , . a small proportion escape it ; and it is regarded by many as a safety-valve in 

preventing convulsions. When nervous symptoms do supervene on dentition, 
these are seldom relieved until artificial or spontaneous diarrhcsa occurs. The latter is a more 
common accompaniment of dentition in summer and autumn than in winter. Even if the diet, 
given in addition to mother's milk, be a suitable one for the infant when in health, it by no means 
follows that the same regimen should be found equally appropriate when the irritation set up by 
the advancing tooth has temporarily reduced his digestive power. The ordinary diet may then 
become indigestible, and therefore too irritating for the bowels.' — (XI. li.) 

In the Report for the year ending 31st March, 1876, Dr. Jardine observes with regard to foreign 
children in China, that in addition to vicissitudes of temperature to which they are exposed, they 
are generally suckled by native nurses, whose milk, though abundant, is often poor. They thus 
require some additional nourishment, and this is best supplied in the form of cow's milk and lime 
water. At Kiukiang good cow's milk is very difficult to be got. ' In such a dilemma, Liebig's 
food for infants (Mellin's) has been found invaluable at home, and it has preserved the lives of 
many children. Here children soon dislike it or refuse to take it altogether, and then our dietary 
becomes narrowed down to beef-tea, veal-broth, or mutton-tea, as farinaceous food is as a rule in- 
admissible at this period.' — -(XE. 15.) 

At Shanghai, according to the Report to March, 1872, foreign children were in general healthy 
during the winter six months. The occurrence of some cases of dysentery among them in the 
early part of that year, preceded by a short interval the discovery of murrain 
among horned cattle. Milk forms the staple diet of foreign infants in Shanghai, 
and accordingly ' the coincidence is at least noteworthy.' — (III. 85.) From April to September 
of that year, although the mortality among children was comparatively large, neither it 
nor the prevalent health-state of European children during that summer warranted the con- 
clusion that, with proper care, Shanghai is exceptionally hurtful to the very young. The care 
of foreign children, especially during summer, is a matter of much anxiety. Brain con- 
gestion in the infant, the result of heat, is attended as often by diarrhoea as by constipation- 
Much of the illness of children is due to injudicious feeding. Native children at the breast 
swallow rice and vegetables, and appear to thrive. The explanation is that the mother before 
putting the food into the infant's mouth carefully chews it into a soft and uniform bolus, by 
which process she unconsciously transforms all the starch into grape-sugar. In this condition 
the food is i-eadily as.similated, and hence the rarity among Chinese children of those convulsive 
affections which would infallibly follow the extensive use of farinaceous food among foreign 
infants. — (IV. 104.) The climate is not so fatal to child-life as that of India ; indeed, in some 
respects the children in Shanghai would seem to be more favourably situated than children in 
Europe.— (V. 54) The mortality among European children at Shanghai is very trifling. Trismus 
neonatorum, common in India, is rare at this settlement. — (XV. 4; XXII. 7.) 

At Foochow, April to September, 1872, the reporter remarks on the subject of infant 

marasmus and infant mortality. As standards he takes children in England and Wales in 1863 

to 1867, the mortality among them being 155 per cent, in their first year of life; 

among those of the Society of Friends, 11"]. In 1864, of children under 5 years, of 

the well-to-do-class, the deaths were 11 per cent,; of agriculturists, 20 per cent. Of children 



SICKNESS AND HEALTH OF EUROPEAN CHILDREN. 223 

artificially fedj 50 to 70 per cent. In Norman dy, the mortality of infants at the breast was 10 per 
cent. ; of those fed by the bottle, 50 per cent. In 1871, of those born in St. Giles, London, 21 per 
cent, died in their first year; in all London, 17; in Bristol, 16-5; Nottingham, 18-7; Portsmouth, 
14-4; Liverpool, 26'9 ; Leicester, 24-1. In India, the average annual mortality among soldiers' 
children during the four years ending 1854 was 68-83 per 1,000; and from 1864 to 1869 it 
averaged 94-41 per 1,000 in Bengal ; in 1869 it -was 145-2 per 1,000 among the children of British 
soldiers in Bengal, so that the rate of mortality among them has gone on increasing. In China, 
statistics of mortality among children of foreigners are difficult to procure ; the reporter considers, 
ho-wever, that much is due to artificial feeding ' by the bottle.' — (lY. 63.) 

In the Report to March, 1882, particulars are given as to the improved health of children at 
this place in recent times as compared with some years ago, and as to some of the circumstances 
to which this favourable change is considered to be due. — (XXIII. 36.) — See ante p. 47. 

According to the Report on Yokohama, the non-occurrence of scarlatina in Japan has been 
already noticed. With the exception of this disease, and cholera infantum, which is very rare, 
children of foreign parentage in Yokohama suffer from the usual maladies of their j^ ^^ 
age. On the whole, however, the death-rate among them is lower than in most 
parts of Europe and America. The comparative rarity of cholera infantum is the more remarkable 
that a large number of the infants born in Yokohama are fed from the bottle. The mortality 
among foreign children at Yokohama is exceptionally small.~(XV. 69, 70.) 



VARIOUS. 

LXXXIV. LESIONS PEOM PUNISHMENT. 

On the island of Formosa, when a thief is discovered in the fact, the mob takes the law into 
its own hands. The hands of the thief are tied behind his back, a stout cord with a running 
noose placed round the arm 4 inches below the axilla, the culprit slung in this way 
to the nearest tree or post, and suspended there for ten to thirty minutes. The 
result is paralysis of the arm more or less complete, the peculiarity being that the great vessels 
escape injury entirely, only the nerves suffering. After some months the use of the arm is 
regained.— (V. 28.) 

In 1874, a man was brought to hospital at Takow, six days after receiving violent injuries 
by way of punishment for repeated acts of theft. His eyes had been very dexterously extirpated, 
some of his fingers so nearly amputated that they were on the point of dropping off, and many 
wounds of considerable length and breadth inflicted on other parts of his body. Many of the 
wounds were so close to important vessels and membranes, that it was difficult to understand 
how these had escaped injury, seeing that the wounds were inflicted with the large knife 
commonly used by the Chinese for domestic purposes. The man, bereft of eyes and with his 
wounds suppurating, presented a most hideous aspect. With good and nourishing food, and 
great attention to the dressing of his injuries, he recovered, and at the end of six weeks returned 
to his home perfectly healed. — (YIII. 14.) 



224 EPITOME OF MEDICAL EEPORTS. 

LXXXV. BEQUEST FOR MUTILATION. 

In 1877j a native Chinese requested the medical officer at Shanghai to amputate his two 
ring-fingers. The request was of course refused ; but on inquiry the cause of its being made 
was found to be that the person making it — aged about 35 — was anxious to join 
the Pootoo priesthood, and that this ordeal had accordingly been placed before, 
him in order to test his devotion. It is added that the man was much put out by the refusal, 
and went away expressing his determination to have the operation performed elsewhere. — 
(XIV. 45.) 

LXXXVI. BANDAGING THE FEET OF CHINESE GIEIS. 

In the Report on Hankow, January to March, 1872, a case of amputation at the ankle-joint 
is recorded, and in reference to it, some interesting particulars given with regard to the method 
followed for contracting the feet of Chinese girls. A woman, aged 26, had 
suffered during five years from disease of the metatarsal bones of the right footj 
with large ulceration on the plantar and dorsal surfaces. Previous to the onset of the disease 
she had frequently walked a distance of 60 li (20 miles) in one day without fatigue ; and 
the reporter observes that in the districts around Hankow, bandaging the feet does not interfere 
with progression so seriously as is often imagined. Walking, he says, is almost dependent on the 
heel of the foot, the knee-joint is kept rigid ; the calf of the leg atrophies, but the muscles of the 
thigh become well developed. [Not in all cases, certainly, for in Tientsin I have seen a very 
well-developed calf in a woman whose feet were contracted. — 0. A. G.] In the present instance 
bandaging had been commenced at the customary age, namely, the fifth year. The healthy foot 
measured 5 inches in length, the ball of the toe and the heel approximated to each other, and 
were separated by an abrupt cleft 2| inches in depth, which represented the arch of the foot. 
Rolling of the foot is effected by means of a cotton bandage 4 yards long and 3 to 4 inches 
broad, wound round the foot and ankle, and reversed so as to make it lie smoothly. The period 
necessary for accomplishing the wished-for alteration does not appear to have been very accurately 
determined. Details of particular cases then follow. — (III. 48.) 

LXXXVII. CHINESE NOMENCLATUEE OF THE EING-FINGEE. 

It appears that in every one of the ten Turanian languages from Finland in the west to 
Manchuria, the northern portion of the Chinese Empire in the east, the ring-finger is known as 
' the finger without a name.'' In the Dravidian languages of Southern India it is also called 
'the finger without a name;' and in these its designation appears as a Sanscrit name, and not as 
a Dravidian. In Tamil, Telugu, and Canarese, it appears as andmiha, ' the nameless thing,' from 
the Sanscrit ndma, a name, with the a privative prefixed. The Chinese name this finger 'the 
nameless digit,' ivu-ming-chi. The other fingers are called respectively, thumb, index, middle, 
and little finger. The term 'nameless finger' is used by Menchis, Book vi. Part i. cap. xii. 1. 
— (VIII. 28.) 

LXXXVIII. DIGITAL SIGNATURES. 

Dr. Fauld's observations on the finger-tips of the Japanese have an ethnic bearing, and 
relate to the subject of heredity. For twenty years Mr. Herschel had charge of a registration- 
office in India, where he employed finger-marks as signs-manual, the object being to prevent 



CHINESE EUNUCHS. 225 

personation and repudiation. Doolittle, in Us ' Social Life of the Chinese/ describes the custom, 
"which well-informed natives consider came into practice subsequent to the Han period. In 
China, great importance is attached in courts of law to this digital form of signature, or 
' finger-form.' Such signatures are sometimes required in the army to prevent personification ; 
when the description of a ' recruit ' is written down, the relative number of ' whites and coniferous 
finger-tips is noted.' Fortune-tellers discourse on these rugae ' as glibly as phrenologists do on 
bumps.'— (XXII. 47.) See Nature, 28th October and 25th November, 1880. 

LXXXIX. CHINESE EUNUCHS. 

The Chinese boldly castrate men and animals. By some method, the nature of which does 
not transpire, they have discovered the dependence of conception upon the presence of the ovaries ; 
and acting upon this knowledge, they castrate boars and cocks, and spay sows with remarkable 
skill and success. The operation of castration is mentioned by native historians B.C. 1100, when 
it was by edict constituted one of the recognised punishments for certain offences. The 
reporter observes that, although in the instances stated its object was punitive, yet he would 
advocate it for preventive purposes, so as to prevent criminals of the worst class from founding or 
increasing criminal families. 

In China as elsewhere, eunuchs are in general made to qualify them to act as palace servants, 
and occasionally as palace executioners ; certain lamas also, who act as domestic chaplains, are 
eunuchs, and for these several purposes there are numbers of willing candidates who voluntarily 
submit to the necessary qualification. The operation is performed at an establishment main- 
tained for the purpose. The operators are known as hnifers. The operation is completed by one 
sweep of the knife j a pewter plug is inserted in the urethra, paper soaked in cold water applied 
to the parts, and healing is complete in about one hundred days. About 2 per cent, of those 
operated on die; some by haemorrhage, some by extravasation, and some by irritative fever. 
For a long time afterwards, however, incontinence of urine persists. 

Eunuchs are described as being hysterical, easily moved to violent anger, easily appeased, 
readily amused or depressed, timid, honest, charitable. 

The practice of castration is of great antiquity. The earliest notice of eunuchs occurs in the 
Bible, and has reference to Egypt. It prevailed in various nations of antiquity, besides the 
Chinese j namely, in Rome, in Greece, and among the Jews. Athenaeus [Deipnoso^h., xii. 9, 11) 
preserves accounts of the practice among the Medes and Lydians, and says that the latter nation 
had discovered the secret of ovai-iotomy. The Yalesians, early in the fourth century, devoted 
themselves to making eunuchs until in a.d, 325, the Council of Nice reproved the practice. The 
Valesians are in modern days represented by the Russian Skoptsy, who perform emasculation 
either complete or partial upon themselves. The operation appears frequently among the 
penalties of the ancient Germanic codes. Adverting to experiments regarding the effects of the 
operation in animals performed by M. Poncet ('Archives Gdndrales de M^decine,' October 
1877, p. 495), Dr. Jamieson observes that, as far as they have gone, they do not appear to upset 
any of the notions commonly held with regard to those effects. — (XIV. 51-54.) 



29 



PART III. 

THERAPEUTICS AND DRUGS. 

I. HISTOEICAL NOTICES. 

Although in China the art of medicine is in decadence, and for the most part in the hands of 
empirics and charlatans, the art of pharmacy appears to be in a better state, notwithstanding that 
medicaments in themselves simple, or based upon superstition or empiricism, are 
often used ; also that particular drugs are believed to have special curative powers in 
regard to particular diseases. However this may be, and although many substances in themselves 
inert are made use of, it is no less true that long experience and patient observation have taught the 
Chinese the indisputable properties of a large number of remedies. Thus it is beyond doubt that 
from a very early date they have known how to induce anassthesia, general or local, 
employing for that purpose certain fungi or the root of aconite. [In reference, 
also, to certain 'magic rituals,' in connection with the worship of Maitreya Buddha, 'soporific 
incense' (see ante, p. 69) was lighted, and the victims thrown into deep sleep. 'This soporific, 
or " soul-conf user," as it is called, makes people feel tired and sleepy ; they are recovered by means 
of charm and cold, water.' It is observed also that the use of an anaesthetic, prepared from hemp, 
has been known to the Chinese for the past sixteen centuries at least. — "From ' Historic China,' 
p. 160.] Mineral medicines are little employed, the materia medica being almost entirely com- 
posed of vegetable preparations. The number of plants thus used is immense, and includes 
nearly all that grow in China. Various animal substances also are used, including the bile of 
bears, deers' horns, glue from donkeys' skins, ambergris, the bezoar of ruminants, bones, whiskers 
and claws of tigers, and some matters the most filthy in nature in the same way as Therinea was 
formerly used among ourselves. Some drugs formerly imported into Europe from China have 
fallen into disuse, more especially ginseng and galingal, Alpinca galanga. China still furnishes 
musk, rhubarb, cubebs, cardamoms, ginger, camphor, cassia, bark, canella, etc. 

Chemistry is in the most primitive condition among the Chinese ; the chemical productions 
few in number, but nearly all of them used in medicine. Mercury is found native in several 
localities. Calomel is manufactured by means of processes more or less com- 
plicated ; so also is vermilion. Carbonate of potass is obtained by the incineration 
of polygonum, artemisia, and other herbaceous plants in the provinces of Shantung and Chihli, 
By subjecting to certain processes the efflorescence by which the soil in extensive tracts of 
country in these provinces is covered, chloride of sodium, carbonate of soda and saltpetre are 
obtained. Marine salt is obtained along the shores of the Gulf of Pechili by spontaneous 



HISTORICAL NOTICES. 22/ 

evaporation of the sea-water and that of marshes. Alum is furnished by Formosa. Sulphate 
of iron and sulphate of copper are obtained in several provinces of the empire. (Catalogue 
special de la Collection exposee au Palais du Champ de Mars/ Paris, 1878, p. 56.) 

AccordiDg to Dr. Dudgeon, the native Chinese practice is strictly TiomoeopatMc — things in 
nature from their resemblance to things in man, who is considered a little world, are prescribed. 
This theory is carried out in its fullest detail according to Chinese philosophy ; 
things according to their tastes, etc., being portioned out to the viscera that belong 
to such a taste. Thus walnuts are ordered in cases of disease of the testes ; Siberian crab in 
ulcer of the breast; canine urinary calculi in want of tone of the heart. The Chinese possess 
numerous aphrodisiacs and also anaphrodisiacs, several of both of which Dr. Dudgeon enumerates. 
A remedy for procuring longevity and preventing the advance of debility is the ' pine-ceiling dew.' 
A hole is dug under a fine old fir ; the central root is taken, a jar of wine placed under it, and 
fire under this again ; the alcohol fumes enter the tree with the sap, and the leaves for a few days 
assume a marvellous green tint. In a few days more the tree dies, the sap on returning distils iuto 
the wine-jar, and this is drunk for the above purpose. It was so by the Emperor Kienlung. 
—(IX. 31.) 

Culinary and dietary regulations abound in China. For example, eatables that are not incom- 
patible should be selected for the same meal. Articles which when taken separately are whole- 
some, become noxious when in combination, so much so that they may be classed as 
poisonous. The most noted of these is a mixture of honey and onions. In some 
places they are employed for suicide, and cases of death from this cause are frequently reported. 
Honey and Chinese dates, i.e. Zizyphtis jujuha, are interdicted, So are eel and sugar-cane. At 
Shanghai, a death, was reported from eating crab and persimmon, i.e. fruit of Diosjiyros Tcaki. 
On these subjects, the great authority named is the physician Sot Szemiao. He was canonized 
early in the seventh century. — (XXII. 45.) 

A very large number of foreign drugs have found their way into the Chinese herbal. Some 
were introduced from India by the Buddhists, and others during the Yuen dynasty, when the 
Mongol armies overran Asia and part of Europe, and a Mongol Khan sat on the 
throne of China. The names of sucb drugs are foreign, and many of them can '"^'' 

be identified. Several of these are noticed in connection with the native Chinese method of 
treating asthma. — See ante, p. 177. (IX. 37.) 

II. AILAKTHUS GLANDULOSA. 

The Ailanthus glandulosa is a very common tree at Peking. There are two varieties of it, namely, 
one fragrant, called ch'un, and one foetid, called shu — the latter growing on the hills. According to 
the Chinese, it may be used as an antidote against sulphur, arsenic, and gold. It 
is also anthelmintic J 'it is used in demonology against the transfer of disease 
from a corpse ;' in dysentery, diarrhoea, prolapsus ani, and leucorrhoea. It is sometimes 
prescribed alone; at other times with ti-yu, or the radix hedysari. It is strongly recom- 
mended in all cases of heemorrhage, from whatever cause or locality. It is diuretic, and may be 
used in gonorrhoea and spermatorrhoea. The inner white bark of the root and stem of the tree 
of the more fragrant kind are the parts used. It is sometimes prescribed along with kolilo 
Cko-tze), the fruit of the Terminalia chehula, also astringent, aa. 4 tael ; the powder of 30 cloves; 
vinegar q.s. — to be made into pills, of which 50 are to be taken at once with ginger. The follow- 
ing are some of the prescriptions for chronic dysentery, in which this remedy plays a part : Bark of 
non-fragrant ailanthus, 4 taels ; Mn-yin-hva (flor. Lonicera Chinensis), 2 mace 5 candareens ; 

29—2 



2-J8 EPITOME or MEDICAL REPORTS. 

charcoal of ti-yu, hung-liwa (Carthamus tinctorius), aa. 2 mace; tang-kwei (rad. Levistici cWnensis), 
1 mace 5 cand. ; liquorice^ 5 cand. ; winCj If catty; water, 3 cupfuls — to be boiled down to 
1 cupful and divided into four doses : the whole to be taken in one day. For the dysentery of 
children : Inside white bark of ailanthus, to be ground, mixed with water, and made into small 
pills with jujubes. In cases of incessant dysentery, day and night, the same bark is to be 
infused in river-water for three days, the outside yellow bark to be scraped off, the inner skin to 
be dried, pulverized, and to each tael 2 mace of mu-Mang (Oostus amarus) to be added, and the 
whole made into pills with soft-boiled rice ; the dose to be 1 mace 2 cand., to be taken on an 
empty stomach with congee. In passing nothing but blood, and the bowels painful, the recipe 
is : The white bark of the root, washed, scraped, dried, pulverized, and made into pills with 
vinegar; and 40 or 50 pills to be taken on an empty stomach with congee; the above for 'red 
dysentery.' In ' red and white dysentery,' i.e., blood and mucus, the same as the above, without 
the vinegar ; the dose of the powder being 1 mace, said to be very efficacious. In leucorrhoea it 
is combined in equal parts with hwa-shih (a kind of soapstone containing alumina instead of 
magnesia), and made into pills with rice, of which 100 pills are to be taken. The follow- 
ing is a standard Chinese prescription against dysentery : 

5« Chw'an hwang lien (rad. leontise) from Szechuen, I mace 2 cand. 
T'iao-hwang-k'in (rad. Scutellar. viscidul^), 1 mace 2 cand. 
Chih-pai-sho (rad. Peeonige rubrse), 1 mace 2 cand. 
San-cha-jow (fruit of Crataegus pinnatifida), 1 mace 2 cand. 
Chih-k'o (a kind of citrus), 8 cand. 
Chw^an-how-po (bark of Magnolia hypoleuca), 8 cand. 
Chw'an-ping-lang (betel-nut ?), 8 cand. 
Ts'ing-p'i (fruit of Citrus microcarpa), 8 cand. 
T'ao-jen (kernels of peaches), 1 mace. 
Hung-hwa, 3 cand. 
Chw'an-tang kwei, 5 cand. 
Ti-yii, 5 cand. 

Sheng-kan-tiao (liquorice), 6 cand. 
Water, 5 cupfuls; to be boiled to 2. 
•J candareens, mu-hiang to be added, and the whole mixed. 

This medicine is not to be thrown away, but again used; 3 cupfuls of water being again added, 
and boiled down to 1 cupful. 

Credit is given to M. Dugatfor bringing the virtues of the ailanthusto the attention of French 
surgeons in the navy in Eastei-n waters, and of medical savants at home. — (IX. 28.) 

Mons. M. E. Dugat, physician to the French Legation in China, states that, in 1872, the 
modes of preparing and of administering the root and bark of the ailanthus in cases of dysentery 
were described to him by one of the Lazarist missionaries at Peking. To prepare it : Take 
15 to 20 drachms of the fresh bark, pound it in a mortal-, aiding the operation by the addition of 
a few spoonfuls of cold water. Express the pounded bark through linen. The juice thus 
obtained is the remedy. The mode of administration is : the bottle being shaken, a tea-spoonful 
is taken in a cup of weak tea for four consecutive mornings, fasting. The diet meantime to be 
exclusively milk during the earlier days ; farinaceous food may be gradually introduced. Cases 
are then related to illustrate the advantages of this method of treatment of chronic forms of the 
disenso.— (X. 22.) 



AILANTHUS GLANDULOSA. — ARSENIC. — CITRATE OF CAFFBINE. — CANNABIS INDICA. 229 

The medical officer at Chefoo states in Ms Eeport for 1873 that he had his attention drawn to 
the Ailanthus glandulosa (choo-chun-shu) as a native remedy for dysentery. The tree belongs to the 
N. 0. Xanthoxylaceae. It was introduced into Europe in 1751, and is now, among 
other places, seen ornamenting the squares and boulevards of Paris ; also in the 
Royal gardens at Kew. At Peking it is used by the Chinese as already stated in the treatment 
of dysentery, and missionaries who have used it among themselves attest its value. It has also 
been used with success by MM. Dugat and Bretschneider at the French hospital at Peking, in 
cases of chronic dysentery. The bark of the root is the part used ; this is pounded in a mortar, 
and mixed with a little water until a pulpy consistence is obtained. It has an intensely bitter and 
astringent taste. — (VII. 21.) 

In the Eeport to September, 1874, Dr. Myers gives details of three cases of dysentery treated 
by the ailanthus, and winds up his remarks as follows : ' In the first case the effect of the 
remedy was negative ; in the second, there seems to be evidence that it may sometimes have 
a positive (beneficial) effect; ia the third, we have great reason to believe that the change 
for the better was due to climatic influences, and this seems reasonable when we mention that 
there was a change from wet and miserable weather to a fine dry and bracing atmosphere 
simultaneously with the first use of the ailanthus.' — (VIII. 53.) 

According to the Report for the year to September, 1875, a seaman arrived at Chefoo 
suffering from a severe and acute form of dysentery; ailanthus produced vomiting and 
distressing abdominal pains. Dr. Carmichael therefore abandoned the drug ; in its place 
prescribed mercury with chalk and compound powder of opium, which produced speedy relief, 
and complete recovery in the course of a fortnight. — (XI. 2.) 

III. AESENIC. 

According to the summary of Chinese medicine, given by Dr. Macgowan in his Report on 
Wenchow, April to September, 1881, hartall (see ante, p. 71), arsenic bisulphide, called also 
orpiment, and king's yellow, is used as a prophylactic against malarious and c^emoiu'aca^ iufluences; 
infinitesimal doses being taken with cinnabar, in a little liquor, on the fifth day of the fifth 
moon, Dragon festival. In the case of children it is smeared on the forehead. — (XXII. 22-32.) 
See Peeiodic Fevebs, Wenchow. — See ante, p. 111. 

IV. CITEATE OF CAFFEINE. 

Dr. Stewart, of Poochow, gave citrate of caffeine in two-grain doses for megrim, and found 
the drug useless. In four-grain doses, repeated after an hour or two, it was of decided benefit. 
He considered the two-grain doses ' as useless as the two-grain doses of oxalate of cerium.' 
(XXIII. 36.) 

V. CANNABIS INDICA. 

Cannabis indica was introduced into China from India (see ante, p. 226). It is called in 
Chinese books ta-ma, the great hemp ; hwo-ma, fire-hemp ; also han-ma, a word not unlike the 
German hanf, and our hemp. The male plant is called si-ma, and p'tn-ma ; the female h'ii-ma 
and tze-ma; the flowers are called ma-pen and ma-po. ' Ma-po will cure every sort of bad vapour ; 
it is an antidote against forgetfulness, confers prophetic powers, and will give a knowledge of 
what is about to happen in the four quarters of the globe.' Linseed, hu-ma, or the sesamum, is 
its antidote. ' If too much hemp be eaten, devils may be seen ; in fact, it is taken by those who 
indulge in spiritualism.' It is recommended as a cure for scorpion-bites; it stops the advance of 
age. It is, however, seldom used medicinally by the Chinese. 



230 EPITOME OF MEDICAL REPORTS. 

Bang, i.e., Cannabis indica, was employed in China a.d. 220-230, as an amesthetic by the famous 
surgeon Hwato during the dynasty of the Wei. It was then used for this purpose where 
acupuncture or the moxa was applied, and it produced such anaesthesia ' as if the patient had been 
either drunk or dead/ so that cuts, amputations, etc.^ were performed without sensation being felt. 
The term ma-yoh is applied to anaesthetic medicines as a class ; not to any one drug in particular. 
—(IX. 37.) 

VI, CAEBOUC ACID. 

In the Eeport on Foochow to March, 1873, Dr. Somerville wrote, in reference to a case of 
gunshot- wound in the person of a Chinese, the hand being blown away at the wrist-joint : — Ampu- 
tation through the forearm was employed, and antiseptic dressings on Lister's 
method applied. There was no bad symptom, and the wound united by the first 
intention. As a rule the Chinese make excellent surgical patients. They stand operations well, 
and recover from them readily. After an experience of Lister's dressings of four years' duration. 
Dr. Somerville ' cannot speak too highly of their value, and no doubt much of the success must 
be ascribed to them; but even during the old system of water- dressings he used to notice how well 
surgical cases got on in natives.' He notices a property of carbolic acid to which, as far as he is 
aware, little attention has been drawn, namely its power of producing local aneesthesia. He had 
noticed that a patient suffered no pain in a wound from the time it was dressed with this sub- 
stance ; also that in the fingers of the dresser there was a feeling of numbness. In the Journal 
of Cutaneous Medicine for June, 1870, Sir Erasmus Wilson showed the value of carbolic acid in 
producing anaesthesia previous to the application of caustics to lupus and epithelioma. Similar 
effects of the drug are related in the American Journal of Medical Science for October, 1870. 
See Braithwaite's 'Retrospect of Medicine,' vol. Ixii., p. 382, and vol. Ixiii., p. 171. — (V. 39.) 

In the Eeport on Chefoo, January to March, 1872, the medical officer writes : ' I would here 

mention the well-marked effect which the inhalation (not by spray, which appears injuriously 

stimulant) of carbolic acid has in advanced cases of phthisis in apparently arresting 

the further deposit of tubercle, besides alleviating the distressing symptoms. 

— (IIL 39.) 

VII. CHEYSOPIIANIC ACID. 

Dr. Stewart, of Foochow, has seen Ghryso])hanic acid act most beneficially in all forms of skin 
diseases due to cryptogams ; he has been taught to look upon it as a specific in these diseases, 

F och w ^^^ even more reliable in them than quinine is in malarial poisoning. He used to 
employ it in 1 and 20 per cent, strengths ; he now often uses it undiluted or unmixed, 
and that to a raw sore ; applied to a raw on the skin he has found it act energetically as a healer 
and diminisher of smarting pain. He has known it cure quickly both ringworm pure and ringworm 
aggravated to a very high degree by eczema, when sulphuret of calcium and other remedies had 
failed; indeed, seeing what an offensive compound the sulphuret of calcium is, he does not see 
why it should ever be used while chrysophanic acid is to be had. In that cryptogamic form of 
disease which, attacking the palm, goes on to burrow and spread till the whole surface of the palm 
is changed, and little is left of it except cracks connected by thin fibres of skin, chrysophanic 
acid does not, without being given a due amount of time, effect a cure. It requires from two 
months to half a year at least for that. The long-continued use of chrysophanic acid gives rise 
to conjunctivitis. The conjunctivitis is not severe, and rapidly passes off on giving up the 
chrysophanic acid for a short time. — (XXIII. 37.) 



COD-LIVER OIL. — DATURA. — EUCALYPTUS. 231 



VIII. COD-LIVEE OIL. 

In liis Eeporfc on Peking to 31st March, 1875, Dr. Dudgeon gives some particulars in reference 
to Chinese knowledge of cod liver-oil. In the 'Great Herbal,' there are mentioned 31 kinds of fish 
with scales, and 37 without scales. The cod is not known in Chinese waters as far as he is aware, 
and no oil is extracted from the liver of fishes. The use of fish, and fish-oil, however, particu- 
larly shad, is used in the treatment of consumption. That fish is called man-sJian, pai-shan, 
shih-yil, and when dry, feng-man. It possesses the virtue of killing insects, and all sorts of worms 
that infest clothes, and wooden or bamboo articles of fui'niture, and mosquitoes. If its bones 
are put among clothes, moths will not destroy them. It is prescribed in fistula in ano, 
haemorrhoids, bad ulcers, and prurigo pudendi. The oil of this fish ^is a most certain cure in 
pityriasis versicolor,' the cure being effected by one application. — (IX. 22.) 

IX. DATUEA. 

The datura or man-to-lo of the Buddhist classics is foreign to China, having, it is said, been 
introduced from India. On account of the shape of its leaves it is called feng-hieh, and shan- 
kieh. It is recommended in all 'wind' diseases (convulsions). 'When eaten, unconscious 
laughter is set up, and the person acts as if intoxicated. It may be used as an anEesthetic. 
It is used in infusion to wash the feet ; it is also applied to ulcers of the face, in convulsions of 
children, and in prolapsus ani.' — (IX. 37.) 

X. EUCALYPTUS. 

In the Report on Hankow, April to September, 1872, details are given of cases of inter- 
mittent fever experimentally treated with eucalyptus globulus ; the effects, as far as can be 
gathered, being either negative, or result in frontal headache and a feeling of nausea, 
both of which disappeared when the remedy was given up. Dr. Reid, accepting 
the eulogies passed by Gubler on the planting of the eucalyptus, writes that ' the introduction of 
the tree into the malarious districts of China must prove of inestimable value in curing not only 
fevers, but many of the other ills that flesh is heir to.' Such were the anticipations then 
formed regarding it. — (IV. 74.) 

The Report on Shanghai for the half-year ending 30th September, 1875, states that attempts 
have lately been made, with but scant success, to domicile there the Eucalyptus glohulus, as a 
means of counteracting the influence of marsh miasm. It is pointed out that in 
India similar attempts have failed; in lower Bengal it thrives as a seedling, 
but becomes sickly after eighteen months, and generally dies before the third year. In the north- 
west provinces its fate has been various ; but the conclusion is that it is unsuited to swampy land, 
and it is unable to resist the hot winds of the south-west. — (X. 68.) 

On the subject of eucalyptus, Dr. Macgowan, in the Report on Wenchow, April to September 
18S1, writes: 'It is extremely desirable that the Imperial Government or the Governor- 
General of the southern provinces should be moved to introduce eucalyptus trees 
extensively, the prophylactic of malarial fever, which is so injurious to the best 
interests of the State. Although the various species that he experimented on were unable to 
endure the cold of a Shanghai or Ningpo winter, the plants rarely thriving beyond the third 
year, yet farther south the result has been all that can be desired.' Dr. Macgowan adds : ' It is 
true that recent observations are unconfirmatory of the anti-miasmatic properties of this exotic 



232 EPITOME OF MEDICAL REPORTS. 

in Algeria and California. A minister like Tso Tsungtang, whose recent work on tree-plaating 
in Kansuli is unequalled by any like feat in history, requires no solicitation to favour such an 
undertaking as the acclimatization of useful plants.' — (XXII. 

XI. IODINE. 

Iodine and some of its preparations enter largely into medical practice. In Chinese books, par- 
ticularly the ' Pen-tsao/ there are notices of sea-weeds, noted as possessing well-known therapeutic 
properties, as in the discussion of hard tumours, goitre for example. They have long been ac- 
quainted with its general properties, and mention various kinds found along the Eastern Seas, on 
the coasts of Corea and the Malayan Archipelago. The chief kinds mentioned in their ' Great 
HerbaP are the hai-tsao, Itwen-pu or lun-pu, hai-tai, hai-yiin, shui-sung, shi-faii., yueh-wang-yii-sivan. 
The botanical names of neither of these are forthcoming. The poor people in Shantung and 
other of the coast provinces eat sea-weed plentifully, as a vegetable, and medicinally ; they 
use it also as a manure. It is prescribed alone chiefly as a tincture, or is mixed up with other 
medicines in various prescriptions. The uses to which these various kinds of sea-weed are put 
correspond with the uses to which one formerly put burnt sponge and other sea productions 
before the discovery of iodine. The Chinese for centuries have prescribed it in swellings and 
tumours of all kinds. They prescribe it also as a diuretic, and assert that ' it is capable of 
driving away any number of demons.'' Two examples of prescriptions of sea-weed are given in 
the Eeports before us. One, which dates from the thirteenth century, is as follows, namely : Hai- 
tsao, 1 catty ; spirit, 2 sheng. To be put in an open bag and digested for two days in spring and 
summer, and three days in autumn and winter ; about an ounce to be taken three times daily. 
The second dates from several hundred years earlier, and is as follows : Hai-tsao, 1 tael ; hiuang- 
lien (justicia), 2 taels. Grind to powder and eat it regularly, avoiding fatty things, and things 
difficult of digestion. As a diuretic the following is the prescription : Kwen-pu, 1 catty. To be 
digested in a kettle of rice-water, and then cut into slices ; again digested to a pulp, to which salt, 
vinegar, soy, orange-peel, etc., are added. In glandular swellings it is recommended to suck or 
chew the sea-weed, and when dry to throw it away. — (VIII. 37.) 

XII. IODOFORM. 

loiloforui has been found extremely useful by Dr. Stewart, of Foochow, in the treatment of 
syphilitic sores ; the same may be said of herpes preputialis. Where he has found iodoform 
most useful is in a bleeding cracked condition of the meatus ani. He had two cases of this 
aifection in which it did away with the necessity for the scalpel. — (XXIII. 36.) 

XIII. IPECACUANHA. 

At Hankow, in the period to September, 1875, two cases of hepatitis occurred, in which large 
doses of ipecacuanha were administered with benefit. — (X. 46.) 

At Canton, April to September, 1872, the use of ipecacuanha in dysentery disappointed ex- 
pectations in two cases ; both attended by severe straining and abdominal pain. In the first of 
these, ipecacuanha was given in a dose of 15 grains ; in the second, in one of 40. The patient in 
the first case refused to repeat the dose; in the second, no improvement followed the use of the 
drug in decreased quantities j and under small doses of mercury the disease was subdued. For 
further particulars see Hepatitis and Dysenteey, See ante, pp. 180-190. — (IV. 70.) 



LU-SHUI. — PARTURIFACIENTS. 233 

XIV. LU-SHUI. 

In the Report on Chefoo for the year 1873^ the medical officer alludes to a substance used by 
the Chinese for preparing bean-curd, and styled ' Native hydrochloric acid.' It is also known by 
the Chinese under the name of lu-shui. It is said to be one of the productions in the manufacture 
of saltpetre, which is found in combination with chloi-ide of sodium impregnating the soil of the 
coast of the Gulf of Pechili; some localities being distinguished by the combined salts forming a 
white efflorescence on the surface. The poisonous product is the liquid incapable of crystalliza- 
tion in the extraction of the salt. It is poisonous in doses of from one fluid ounce. A woman in 
the village of Tingshin had taken a small quantity ; an emetic was administered, and she recovered. 
The substance was given to five dogs, but the post-mortem appearances were not the same 
in any two of them. In the case of a horse to which the substance was administered, the appear- 
ances of strong corrosive action were unmistakable, and did not present any similarity to those 
seen in the dogs. — (VII. 21.) 

XV. PABTURIPACIENTS. 

Native Chinese books are rich in prescriptions for rendering parturition easy, and for 
procuring abortion. Private recipes belong to the class of secret remedies. The more powerful 
of the former become abortive agents. They include the following, namely : the seeds of 
Impatiens balsamina, ginseng, sandai'ach, kernels of cratgegus and of peach, musk, camphor, oak- 
bark, hemp-seed, gypsum, the Cyperus rotundus, umbelliferas, Leonurus sibericus, seeds of 
Tribulus terrestris, a species of arum, roots of Sida tiliasfolia, seeds of Grleditschia sinensis, 
Ophiopogon spicatum, Eehmannia glutinosa, etc. 'And as the sublime and ridiculous are always 
in China connected,' the following substances also find a place among parturifacients, namely: 
water-turtle, tortoise, hippocampus, flying-fish, a kind of nitrate of potash, fruit of Sophora 
japonica, rice-husks, lotus flowers, large beans found in cow-dung, hair of white cock, albumen, 
blood from the comb of a black cock ; blood, brains, skin, and hair of a rabbit ; ashes of a 
Chinese pencil, rat, mule's hoof, dog's hair, of the wooden handle of any utensil, and of old straw 
slippers ; blood of a white dog and of a pig's heart ; human urine, honey, bile pills, ink, iron 
utensils, ancient cash, rust of spades, arrow shafts, bow-strings, baskets, cart-oil, husband's 
garters, the parturient woman's nails, serpent's skin, deer's dung, lard, mud from a well, water 
in which children have been washed, etc. As rendering labour easy the remedies proceed on the 
theory of their being emollient, demulsive, soothing, etc. This class includes the seeds of 
Pharbitis nil, the seeds and flowers of a mallow, white bark of elm, seeds of Hibiscus abelmoschus, 
plantain. Sorghum saccharatum, a kind of bean (Dolichos or Abrus precatorius), horse betel-nut 
(a fruit from Yiinnan), arrowroot, Dianthus fischeri, Akebia quinata, rad. Clematis sinensis, 
Aralia papyrifera, Alisma plantago, Portulaca oleracea, a kind of buxus, seaweed, wheat-sprouts, 
soapstone (agalmatolites), Typha angustifolia. Besides these substances the following are 
specified, namely: honey, castor-oil seeds, the patient's shoes, an ant-hillock, cow-dung, salt, 
soot, a bridle, the refuse-water after grinding knives ; skin of a red horse, of an otter ; the 
patient's trousers, her hair; mud from the front of a busy shop where animals and men con- 
gregate, etc. There is also a stone called fu-sheng, taken by parturient women to expedite 
labour. 

In the class of more direct abortives are the following, namely : aconite; Arum macrorum, 
pentaphyllum, and other species ; Corydalis ambigua, legumes of Psoralea corylifolia, Phy- 
tolacca, root of Pupalia geniculata, or Achyranthes aspera, rhododendron, henbane, bulbs of 

30 



234 EPITOME OP MEDICAL BEPORTS. 

a cucurbitaceous climber, root of Coix lachryma, rubia, carthamuSj root of Saccbarum spicata, 
bark of Peeoma moutan, root of eupborbia, cyperus, dried ginger, cassia buds, dried Chinese 
varnish (a kind of rhus), fruit of Sophora japonica, croton oil, a kind of Xanthoxylon (Chiuese 
pepper shrub), cantharides, scolopendrum, a number of insects, caterpillars, lizards, sal ammoniac, 
mercury, realgar, orpiment, nitre, red basmatite, bezoar-stone (of oxen), a kind of styrax, 
passerina chamcedaphne, etc. — (IX. 31.) 

XVI. QUININE. 

In the Report on Peking to 31st March, 1874, the medical officer remarks on the inefficiency 
of quinine in the treatment of severe cases of intermittent fever at that capital. He attributes 
this circumstance to the importation of a spurious drug, and writes : ' Nothing is 
so likely to bring contempt upon us and our medical science as the sale of 
adulterated and spurious drugs, and especially of quinine, of which the Chinese have already a 
very exalted and just appreciation.' — (VIII. 29.) In 1874-75, muriate of cinchonine was on 
sale in a native hong. None of the spurious quinine reported as sold in the south of China was 
traced to the capital. — (IX. 22.) 

At Kiukiang, to March, 1875, several cases of gleet of old standing were treated successfully 
by means of injections of quinine, of the strength of one and a half grain of that drug dissolved 

^. , . in an ounce of water, acidulated with a few drops of diluted sulphuric acid, and 

Kiukiang. ,.. . . , . . 

used twice daily. Similar treatment was described as very successful m causing 
fistulous tracts to granulate and heal up ; it is also useful as an eye-lotion in purulent 
ophthalmia after the acute stage has ended. A drop of the solution put into the eye night and 
morning is recommended in such cases. — (IX. 2.) 

In the year to March, 1877, quinine was administered as a prophylactic against malarial 
fevers. In cases of tardy convalescence, notwithstanding its employment, removal to a neigh- 
bouring hill sanatarium was had recourse to. — (XIII. 1.) 

At Hankow, in 1871, quinine, administered in a case of severe intermittent 
developed out of continued fever, produced no effect, and the patient died. — 
(II. 47.) 

At Shanghai, 1871, quinine was useful in the treatment of disease generally. In some 

exceptional cases of double tertian ague it was hurtful : in these. Fowler's solution with 

opium was ' not only permanently useful, but rapidly so. In cases of remittent fever, 

quinine in large doses was occasionally given with success when the pulse was 

over 100. In the severe form of remittent, known as Shanghai fever, quinine in any quantity 

often disagreed.'— (II. 38.) 

Dr. Macgowan, in his Eeport on Wenchow, April to September, 1881, writes : ' It is matter of 

regret that quinine, the anti-malarial value of which the Chinese fully appreciate, should, owing 

„, , to its cost, be unobtainable by the masses.' He accordingly suQ-gests that the 

vreiicliow. ■ . o i/ oo 

cultivation in Yunnan of the cinchona tree should be experimentally tried. — 
(XXII. 48.) 

At Foochow, according to the Report for 1871, fevers, remittent and intermittent, usually 
yielded readily to quinine in large doses given in the intervals between the accessions. In some 

instances, however, it failed, and in these arsenic was administered with better 

i'OOCllOW. , . . 

success, bowlers solution, m doses of 5 minims gradually increased to 10 minims 
three times a day, was the form in which the latter drug was administered under such circum- 
stances. Cases in which quinine failed were, however, quite exceptional. — (II. 27, 31.) 



QUININE. — SALICYLIC ACID. 235 

Tn the Eeport to September, 1872, Dr. Eeid stated that quinine is valuable as a means of 
diagnosis, especially in the hot season, when ordinary heat eruptions may serve to mask the real 
characters of a case of fever under treatment j that this drug is useless in the treatment of con- 
tinued fever. In the West Indies many cases of typhoid are said to be marked at the outset by 
periodicity ; in this stage quinine is valuable, but it loses its power and even seems to aggravate 
the symptoms when they become continued. A case is then recorded as that of a patient who had 
resided eight years in China, and who during that period had no serious illness except during the 
hot season intermittent fever with gastric disturbance and constipation. He died of 'mixed 
fever.' Until attacked by it the intermittent fever had always yielded to moderate doses of 
quinine.— (IV. 58, 59.) 

At Tamsui, in the year ending 30th September, 1878, a case of remittent fever is recorded, in 
which, quinine having had no marked effect, change of climate appears to have been instrumental 
in bringing about recovery. In a case detailed, the attack of intermittent fever 
was very severe. After several repetitions of individual attacks, which were treated 
during the intervals between them with ten-grain doses of quinine, the patient still suffered 
from extreme headache and want of sleep, which yielded to bromide of potassium and opium. 
—(XVI. 18.) 

At Taiwan and Takow, 1871, quinine, successful in cases of intermittent fever, was not 
so in malarial neuralgia. In the latter, arsenic was administered with good 
results. In it, hypodermic injection of morphia had no permanent effect. 
—(II. 67.) 

According to the Eeport on Swatow to September 1871, a case of secondary fever, 
following cholera, was treated successfully with large doses of quinine. — 

At Canton, April to September, 1872, the reporter observes, in reference to quinine, that there 
are many fevers in which the drug has no sphere of action, and in which expectant and general 
treatment must be adopted ■ and secondly, ' the Chinese can, to a very considerable _ 
extent, cure with their own medicines the cases which it cures ; they can generally 
cure intermittent fevers with their own drugs, so that the superiority of quinine is not very 
marked in their eyes. They use quinine in ague, and this medicine is in increasing demand every 
year ; but in any other form of intermittent fever not preceded by regular cold stage, it is not 
used.' In remittent fevers of a paroxysmal character, it is his impression that the Chinese effect 
cures in 80 per cent, of cases if the patients are early treated, and quinine can do no more than 
this.— (IV. 71.) 

In the summer of 1879 a peculiar form of remittent fever prevailed. Quinine seemed to have 
no effect upon it, either in large or small doses. In one case the use of the drug was discontinued 
after the patient had been cinchonized seven days. Quassia and dialyzed iron was then given with 
good effect. — (XVIIL 57.) See also Malaria, Periodic Fevers. 

XVII. SALICYLIC ACID. 

The results of trials regarding the therapeutic action of salicylic acid are recorded in the 
Eeport of Chinkiang for the year ending 30th September, 1878. The administration of the drug 
was found to be difficult in consequence of the degree of irritation of the fauces set 
up by it. In combination with the liquor acetatis ammonige, it was found useful in ™^' 

rheumatism ; but the action of the vehicle as a diaphoretic is to be borne in mind. In fact, the 

30—2 



236 EPITOME OP MEDICA.L REPORTS. 

result of trials made with it iu the treatment of chronic rheumatic arthritis, typhoid and inter- 
mittent fevers, gave average results 'the reverse of satisfactory.' As a local application, however, 
in diphtheritic pharyngitis, catarrh and worms, it was more satisfactory. Also, with glycerine, 
in chronic eczema of the feet, so common among foreigners in China. — (XVI. 21.) 

XVIII. TONGA. 

At Chinkiang in 1881-82, Dr. Stewart wrote of tonga, that he had no high opinion of it. 

Given along with citrate of caffein, say within half an hour or an hour after a four-grain dose of 

the citrate, when the latter did not appear to be taking full effect; — in cases of 

Chinkiang. ^ggrim— he has found tonga advantageous, more so ' perhaps ' than a second four- 
grain dose of the citrate would be, — (XXIII. 37.) 

XIX. MEMORANDUM ON TEEAK FAEOOK, OE THERIACA ANDEOMACHI. — [See ante, p. 163.) 

The nature of the drug so named and the method of its preparation having both passed out of 
general knowledge, it is believed that the particulars now to be given in regard to these points 
may be considered to have at least some historical interest to justify their introduction here. 

In the work of Dr. Freind on the ' History of Physic,' 1726, vol. ii., p. 209, the author wrote : — 
'Mithridate and the treacle of Andromachus have been in use for near two thousand years, and 
are still allowed to be good medicines by the ablest judges ; and yet were we to examine every 
particular, we should probably be at a loss by any force of reasoning to comprehend why this or 
that drug should have been made choice of, or how it could add to the efficacy of the medicine.' 

According to Pomet ('History of Drugs,' 1737, p. 278), 'Treacle, commonly called Venice 
treacle, is a composition of certain choice drugs, prepared and reduced into an opiate or liquid 
electuary with honey. The treacle takes its name from the viper, which the Greeks call therion, 
or thyrion. The Venetians of late years have got the reputation of being thought the only people 
who had the true way of preparing the treacle.' 

Among the medicines recommended in 1528 by Dr. John Kaye for the ' sweating sick- 
ness ' then raging, were theriaca, Armenian bole (consisting of chalk and oxide of iron), and 
pearls, each of which occurs in various combinations (Hecker's ' Epidemics of the Middle 
Ages,' pp. 303 and 371). And all were used as prophylactics against the prevailing 
epidemic. Theriaca is thus referred to in the work of that physician, entitled 'A Boke or 
Counseill against the disease commonly called the Sweat, or Sweating Sickness, made by John 
Gains, Doctor in Physicke, anno 1652 ■": 'For in al the discoui'se preseruativ and cure, of thys 
disease, the chefe mark and purpose is, to minister suche thynges as of their nature haue the 
facultie by colyng dryenge and closing, to resist putrefaction, strength and defende the spirites, 
comforte the harte, and keep all the body agenst the displeasure of the corrupt aire. Whei'efor 
it shal be wel done, if you take of this coposition folowyng euery morning the wight of ij.d. in vi. 
sponefulles of water or iuleppe of Sorel, and cast it upon your meate as pepper. IJ; sels citri 
acetos. ros. rub. sadal. citrin. an. ^i.; boli armeni orietal 5i. s.; terr sigil. 5s.j margarit, ji.j fol. auri 
puri n°. iiij.; misce s. f. pul. diudatur ad p5d 5s. Or in the steade of this, take fasting the 
quantitie of a small bene oi Mitliridatam or Venice treacle in a sponeful of Sorel, or Scabious 
water, or by the selfe alone.' 

In ' The Druggists' Shop Opened,' by Williani Salmon, 1693, it is stated (p. 745) that among 
the remedies recommended against bites by scorpions were mithridate, Venice treacle, ' our 
London treacle,' etc. 



MEMORANDUM ON TBEAK FAROOK. 237 

Dr. "William Culleiij writing in 1809, observed that 'Bventlie London College, who in their 
Dispensatory of the year 1746 had shown so much discernment and judgment in correcting the 
luxuriancy of composition^ still retained the Theriaca andromachi in its ancient form.' (See ' A 
Treatise on the Materia Medica/ vol. i., p. 10.) 

According to Dr. Waring, ' Therapeutics/ p. 653, ' Treak Farook is an important article in 
India. Prom a printed paper in Persian characters which accompanies each canister it is pro- 
fessedly the Theriaca Andromachi of old writers, and is prepared in Venice, whence it is exported 
to the East.' Andromachus, whose name the preparation bears, was physician to Nero A,D. 
37-68, According to his biographer he was its ' inventor.' During his ' incumbency ' the drug 
was ' among the necessaries of the Eoman Court.'— -(Hecker, p. 276.) 

"With regard to the theriaca, the following remarks occur in the ' Narrative of the Committee' 
appointed to prepare the Dispensatory of 1746: 'And for the additions made to it by Andro- 
machus, we are not informed of any pretence upon which they were severally added, except that 
by the viper's flesh this medicine was to be rendered more useful against the bite of that animal.' 
— (Galen, ' De Antidot.,' li., c. i.) However, the theriaca gained so high a degree of credit that 
even Marcus Aurelius was prevailed on by his wife to make a daily use of it, to the great prejudice 
of his health, till his head was so affected that he dozed in the midst of business, and then, omit- 
ting the opium in it, was not able to sleep at all. — [Ihid. p. 6.) 

Sir George Ballingall wrote : ' Two native (in India) remedies of great celebrity — the Trealt 
Farooh and oleum nigrum — appear to have been adopted latterly in the treatment of Beri-Beri by 
European practitioners, and are favourably spoken of by Mr. Malcolmson.' — ('Military Surgery,' 
ed, of 1855, p. 598.) 

In the third edition of his ' Cyclopaedia,' Surgeon- General B. Balfour gives particulars in 
regard to Treak Parook. As in the Greek of Galen (theriaM) so in Arabic, ' tiriaq ' means 
treacle, also antidotes of every kind against poisons, and ' tiriaq farook ' is ' the best sort of 
treacle.' Dr. Balfour had a formula for the preparation of the drug from the Commissariat 
Department of Madras, and writes : ' The ingredients were numerous, many of them warm spices.' 
In the second edition of his ' Cyclopaedia ' he wrote : ' TJieriaca veneta, the modern representative 
of the mithridatum of the ancients' (see subsequent note from Grey), 'is sold in little canisters in the 
bazaars of India. On the wrapper is printed, in Persian, " The Theria of Andromachus, an invention 
of Theron the Presbyter. It is prepared, measured, and made public by me, John Baptist 
Sylvester, in the Rialto, by authority of the excellent Government Physicians of Ancient 
Righteousness and of the Council of Apothecaries and Learned Physicians." ' TiriaJci in Turkey 
means an opium-eater. 

It is evident, on reference to Pomet's 'History of Drugs,' 1737, p. 278, that several compounds 
were at that date known under the name of Venice Treacle, or Andromachus's Treacle. Quoting 
from Charra's work in French, entitled, ' The Natural History of Animals, Plants, and Minerals 
that make up the Composition of Andromachus's Treacle,' M. Pomet gives the following receipt, 
namely : 

' Take troches of squills, six ounces ; troches of vipers and hedycroy, long pepper, opium 
prepared, of each three ounces ; red roses, Florentine orrice, juice of liquorice, wild navew seed, 
balsam of Judeea, fine cinnamon, agaric, of each one ounce and a half ; powdered myrrh, Arabian 
cistus, saffron, cassia lignea, Indian spikenard, flowers of camels' hay {Juncus odoratus), olibanum 
in tears, white and black pepper, dittany of Crete {Origanum creticum), tops of white horehound, 
fine rhubarb, Arabian Stsechas (amaraiithus sp. ?) Macedonian parsley seed, mountain calamint, 
turpentine of Clio, cinquefoil, ginger, of each six drams ; poley mountain (Polium montanum), 



238 EPITOME OF MEDICAL REPORTS. 

ground-pine^ storas in the tear, spicknel, true amomum, valerian, Celtic spikenard, sealed earth, 
Indian leaf, natural calchitis, gentian root, aniseed, juice of hypocistis, fruit of balsam tree, gum 
arable, fennel seed, common cardamom, marsilian hartwort, treacle mustard, flowers of St. John's 
wort, the true acacia, gum sagapen in tears, of each four drams ; castor, small birthwort, candy- 
carrots, Jew's pitch, flowers of lesser centaury, opoponax, and galbanum, of each two drams; 
choice honey three times the weight of all ; Spanish wine as much as to give the due consistence.' 

Then follows instructions for the preparation of troches, severally of squills and of vipers. 

It will be observed from what is to follow that the ofScinal preparation known in London in 
the middle of the eighteenth century under the name of "" Theraica Andromachi,'' differs in several 
respects from that just noticed. The following represents the composition of the drug so named, 
otherwise ' Venice Treacle,' according to the 'London Dispensatory ' of 1746, p. 343, viz. : 

' Take of the troches of squills half a pound ; long pepper, opium strained, dried vipers, of 
each thi'ee ounces ; cinnamon, balsam- of Gilead, or in its stead expressed oil of nutmeg, of each 
two ounces ; agaric, the root of Florentine orrice, water germander, red roses, seeds of navew, 
extract of liquorice, of each an ounce and a half ; spikenard, saffron, amomum, myrrh, costus, or in 
its stead zedoary, camel's hay, of each an ounce j the root of cinquefoil, rhubarb, ginger, Indian 
leaf, or in its stead mace, leaves of dittany oE Crete, of horehonnd, and of calamint, French 
lavender, black pepper, seeds of Macedonion parsley, libanum, Clio turpentine, root of wild 
valerian, of each six drams ; gentian root, Celtic nard, spignel, leaves of poley mountain, of St. 
John's root, of ground-pine, tops of creeping germander with the seed, the fruit of the balsam 
tree, or in its stead cubebs, aniseed, sweet fennel seed, the lesser cardamom seeds freed from 
their husks, seed of bishop's weed, of hartwort, of treacle mustard, or mithridate mustard, juice of 
the rape of cistus, acacia, or in its stead gapon earth, gum arable, storax strained, sagapenum 
strained, Lemnian earth, or in its stead bole Armenic or French bole, green vitriol calcined, of 
each one ounce ; root of creeping birthwort or in its stead of the long birthwort, tops of the lesser 
centaury, seeds of the carrot of Crete, opopanax, galbanum strained, Russia castor, Jew's pitch, 
or in its stead white amber prepared, root of the sweet flag, of each two drams j of clarified honey 
thrice the weight of all the rest. The ingredients are to be mixed in the same manner as in the 
mithridate. 

BemarJc. — Here the same cautions in relation to the powdering of the species are to be observed 
as in the mithridate, very little alteration has been attempted in either of these celebrated anti- 
dotes. But for what small variation has been made, see the ' Narrative of the Committee,' 
p. 117, etc.: to which maybe added, that wild valerian is here received upon the judgment 
of Fabius Columna; and rhaharbarum, rhubarb, is inserted instead of rhaponticwn, after the 
example of the Dispensatory of Augsburg, the rhapontic not being used with us otherwise in 
medicine. 

Note. — All electuaries, if they grow dry, should be reduced again to their consistence with a 
small quantity of canary, and not with syrup, or honey; by this means the dose will be rendered 
the least uncertain, which is especially necessary for those that are made up with syrup, and con- 
tain a large quantity of opium, such as the philonium, and the confection bearing the name of 
^aulina. 

Eemark. — The reason for this caution is, that the quantity of the fresh syrup, or honey, will be 
so great as to vary the proportion of the whole to the original ingredients, and make the effect of 
the medicine precarious. 

The following occurs in the ' Narrative ' at p. 117, referred to above, namely : ' The committee 
in their last draught made no further alterations in the ingredients of the mithridate and theriaca 



MEMORANDA ON MITHRIDATE AND OLEUM NIGRUM. 239 

than rejecting sucli as were not in the original, except substituting cinnamon for cassia Ugnea, 
which, it is evident from Galen, was only used through the scarcity of the other (a) ("De Antidote.," 
1. i. c. 14 j "De Sanitat. Tuend.," 1. vi. c. 1), and by omitting the asarum in the mithridate, 
which is inserted on a conjectural emendation only of a corrupted passage in the original descrip- 
tion ; in the theriaca they also changed the name of the vitriol, which modern dispensatories have 
generally substituted under the title of the Roman, for the ancient chcdcitis now not certainly 
known, in order to obviate a mistake, which the first compilers of our Pharmacopoeia have handed 
down to us.' 

Bemarh. — (a) ' Neither the description in verse of the elder Andromachus, nor the prose explana- 
tion of the younger, make any mention of the white pepper afterwards added to the composition 
of theriaca (Galen, " De Antidot.," 1. i. o. 7) ; and the forming the agaric into troches with ginger 
is also another innovation ; in like manner the radix iridls in our description of mithridate (which 
see) is a supernumerary ingredient not warranted by the original.' 



XX. MEMORANDUM ON MITHKIDATE. — {See ante, p. 103). 

The mithridate abovo alluded to is described as "■ Mithridatum, sive Confecfcio Damocritis ;' its 
composition is detailed at pp. 340, 341 of the ' London Dispensatory ' of 1746. 

According to the work by Pomet, already quoted, p. 281, the following is the receipt for 
mithridate ; ' Take of a choice myrrh, saffron, white agaric, ginger, fine cinnamon, Indian 
spikenard, frankincense, and thlaspi, or treacle mustard-seed, of each ten drams; Marsilian 
hartwortj balsam of Judsea, camel's hay, Arabian stsechas, costus, galbanum, turpentine, long 
pepper, castor, juice of hypocistis, storax in tears, opoponax and Indian leaves, of each one ounce; 
cassia lignea, poley mountain, white pepper, water germander, candy carrots, fruit of the balsam 
tree, troches of Oephi and bdellium, of each seven drams ; celtio spikenard, gum Arabic, Mace- 
donian parsley, opium, the lesser cardamom, fennel, gentian, red roses and dittany of Crete, of 
each five drams ; aniseed, the true acorus, small valerian, and gum serapin, of each three drams ; 
spignel, acacia, and the sea skink, St. John's wort-seed, of each two drams and a half ; Spanish 
wine, a sufficient quantity; fine honey, nine pounds, eight ounces and two drams.' Thus it 
becomes apparent that the difference between the composition of these famous drugs is not very 
great. Democritus, whose name is attached to the mithridate, died B.C. 361, at the reputed 
age of 109 years. (See also Grey's ' Supplement to the Pharmacopoeia,' 1828.) 



XXI. MEMOKANDUM ON OLEUM NIGRUM. 

Adverting to the notice by Sir George Ballingall, of the use of oleum nigrum in the treatment 
of Beri-Beri, arde, page 162, the following information regarding the drug so named may be interest- 
ing. Surgeon-General Balfour, in the third edition of his ' CyclopEedia,' writes under the head of 
Celastrus fanicidata : 'The oleum nigrum, an empyreumatio black oily fluid, is obtained by the 
destructive distillation of the seeds, but it does not differ in any sensible degree from the em- 
pyreumatio products of the distillation of common fixed oils, containing naphtha ; large quan- 
tities would doubtless yield parafiine and creasote. The seeds have a hot biting taste, and the 
oleum nigrum obtained from them was at one time largely employed in Beri-Beri. It is stimu- 
lant and diaphoretic. It is called in Tamil " Malkunganee." ' Under the heading 'Oleum 



240 EPITOME OP MEDICAL REPORTS. 

Nigrum/ Dr. Balfour says : ' It is made by putting the seeds of Celastrus paniculata, with benzoin, 
cloves, nutmegs and mace, into a perforated earthen pot, and then obtaining, by a kind of distilla- 
tion ]per descensum into another pot below, a black empyreumatic oil.' 



XXII. MINERAL WATERS. 

There are two celebrated mineral baths near Peking ; one at Pi-yiin-sze, a famous Buddhist 

temple, about twelve miles west from the city; the other at T'ang-shang, twenty miles to the 

_ , . north and about fifteen miles south-east from the Ming tombs. The former con- 

rekmg. . ° . . 

tains sulphuretted hydrogen, and its waters are cold : the latter includes two springs; 
they have a temperature of 120° Fahr. ; their chief ingredients alkaline chlorides, particularly 
chloride of sodium, carbonate and sulphate of soda, bicarbonate of lime, and a little magnesia, 
with sulphate of lime and silica — thus having a likeness to the spas of Baden and Bath, and 
proving, like them, extremely useful in gout and chronic rheumatism. — (II. 81.) 

In the neighbourhood of Chefoo there are sulphur-springs, which are found to be most useful 
in the treatment of cutaneous diseases and constitutional rheumatism. They are much resorted 
. to by the Chinese ; and many foreigners have also benefited greatly by them, par- 

ticularly in cases of obstinate consecutive syphilis. The water bubbles out at a 
temperature of 112° to 120° Fahr., and in the bath preserves a uniform temperature of about 
100° Fahr. An analysis of this water had not been obtained in 1872. — (III. 4.) According to 
the Report for the year from 1st April, 1872, to 31st March, 1873, the mineral baths already 
described are situated at a village called Loong-Chuen-Tang, about thirty-three miles in an 
eas^iern direction from Yentai. At the time referred to, measures were in progress to establish 
means of accommodating foreign visitors who might resort to these baths. In their vicinity, 
tradition says that 'the god of healing' resides. The heat of the sulphurous water varies, 
according to different authorities, from 110° to 119° Fahr. 

Other baths are to be found at a village called I-San-Tang, in a north-westerly direction 
from Chefoo, distant about fifty miles ; the waters said to have even greater virtues than those of 
Loong-Chuen-Tang. At I-San-Tang there are four or five baths, one of which is situated in a 
room, and kept more or less private. The temperature of these baths ranges as high as 124 °Fahr. 
—(V. 20.) 

At Takow and Anping, Eeport for October, 1881, to March, 1882, sulphur-springs exist on 

the shores of a lagoon at the base of hills that form the western boundary of the harbour, as 

well as on the hills themselves. From these springs a discharge of sulphurous acid 

gas takes place at all times ; and to the intermixture of it with the atmosphere. 

Dr. Myers attributes the circumstance that tuberculous patients at Takow frequently undergo 

great improvement in health. — (XXIII. 19.) 

Besides those above enumerated there are many hot springs in the provinces of Shensi and 
Sz'chuen, and at Jeho in Chihli. From those of Sz'chuen au inflammable gas, having a bitu- 
minous odour, arises, and being conveyed in bamboos, is burnt under evaporating vessels contain- 
ing salt water from other springs in the same locality. Some springs are sulphurous, others 
chalybeate, found in Shensi and along the Yellow River. Sulphur-springs occur in great 
abundance in Formosa, the sulphur from these being purified for powder manufacturers. — 
(' Middle Kingdom,' by "Williams, vol. i., p. 312.) 



MEMORANDUM OX ' NA TUBAL SCIENCES.' 241 



XXIII. THE ' NATOEAL SCIENCES ' IN RELATION TO MEDICINE. 

{See ante, pp. 70, 207, 227, 232.) 

Natural history, in its various branches of geology, botany, zoology, etc., is chiefly studied 
for the assistance these respectively give in furnishing articles for the Materia Medica of the native 
physician. As sciences, however, they cannot be said to exist. In all the depart- „, . 
ments ot learning the Chinese are unscientific. In regard to chemistry and metal- 
lurgy the same remark applies, and yet many operations connected with both are performed 
with a considerable degree of success. Sir John Davis gives details of some experiments in 
oxidizing quicksilver, and in the preparation of mercurial medicines performed by a native at 
Canton, which afforded a curious proof of similar results obtained by the most different and 
distant nations possessing very unequal scientific attainments, and bore no unfavourable testi- 
mony to Chinese shrewdness and ingenuity in the existing state of their knowledge. — {' Middle 
Kingdom,' by Williams, ed. of 1883, vol. ii., pp. 118 and 134.) 

Alchemy was pursued in China long before it was kaown in Europe. For two centuries prior to 
the Christian era, and for four or more subsequent thereto, the transmutation of metals into gold, 
and the composition of an elixir of immortality, were questions ardently studied by 
the Chinese. Intercourse between China and Persia was frequent both before and 
after the Mahomedan conquest of the latter country ; embassies from Persia, from the Arabs, 
and from the Greeks in Constantinople visited the court of the Chinese Emperor in Shansij 
Arab traders settled in China j and there was frequent intercourse by sea and land between China 
and the Persian Gulf. China had an extensive alchemical literature anterior to the period when 
alchemy was studied in the West, hence the facts stated go to indicate that this pseudo-science 
originated, not with the disciples of Mahomet, but that it was borrowed by them from the 
Chinese. 

With regard to the philosopher's stone, while the alchemists of the West have spoken with 
doubt as to what it was, with the Chinese its identity appears hardly to have been questioned. 
That wonderful body which, when used as a chemical agent, was supposed to have philosopher's 
the power of converting other metals into gold, and when employed as a medicine, ^'™''- 

of conferring immunity from death, is, according to the writings of the Chinese alchemists, 
cinnabai: Marco Polo notices the idea that sulphur and mercury are capable of pi'olonging life. 
Of the Gingui {i.e., Ghugi, the Jogis in India) he says : ' These are longer-lived than other 
people, for they live from 150 to 200 years ; for they take quicksilver and sulphur, and they mis 
them together and make a drink of them — and they say that it lengthens their life — and they do 
this twice every month. These people use this drink from their infancy, in order to live longer ; 
and without fail, those who live so long, use this drink of quicksilver and sulphur.^ — (See Quarterly 
Review, July, 1868.) 

Ko-hung, author of the ' Pan-p'uh-tsi-p'ian,' a work of the fourth century, enumerates various 
mineral and vegetable productions possessing in different degrees the properties of an eliiclr 
vital. Of the first of them, cinnabar, he writes in terms thus translated by Mr. Edkins : — ' When 
vegetable matter is burnt, it is destroyed; but when the Tan-sha (cinnabar) is subjected to heat, 
it produces mercury. After passing through other changes, it returns to its original form. It 
differs widely, therefore, from vegetable substances, and hence it has the power of making men live 
for ever, and raising them to the rank of the genii. He who knows this doctrine, is he not far above 
common men ? In the world there are few that know it, and many that cavil at it; many do not 

31 



242 EPITOME OE MEDICAL REPORTS. 

know even that mercury comes out of cinnabar. When told, they still refuse to believe it, saying 
that cinnabar is reel, and how can it produce a loMte substance ? They say also that cinnabar is a 
stone — that stones, when heated, turn to ashes, and how can anything else be expected of cinnabar ? 
They cannot even reach this simple truth, much less can it be said of them that they have been 
instructed in the doctrine of the genii.'— (See ' Science Papers/ by D. Hanbury, of 1876, 
p. 622.) 

There is a tradition among the Chinese that the Emperor Shen-nung, or Chen-nong, who 
is said to have reigned about 2700 years B.C., is the Father of Agriculture and of Medicine. He 
,^ ,. . , , , is believed to have put tno'ether the first treatise on medicinal plants, in a work 

Medicinal planls. Jr" & r. oi a 

known as ' Shen-nung-pen-ts'ao-king/ or Classical Herbal of Shen-nung, gene- 
rally quoted by Chinese authors under the name ' Pen-king.' According to Bretschneider, that 
work enumerated 347 medicines, of which number 239 were plants. Mr. Hanbury observes that the 
drugs enumerated are divided somewhat thus : ' There are 120 of the highest class, these are of 
the nature of aliments ; they have no venomous or malignant quality. If you would have the 
body active and nimble, even in old age, make use of the remedies contained in this class. 
There are also 120 of the second class. These drugs perform the function of servants or 
domestic officers ; they give a man a disposition which renders him more capable of performing 
the functions of nature. There are some which have a malignant quality, and others which are 
quite innocent and harmless. There are 125 sorts of drugs of the lowest class, which perform 
the function of officers not belonging to the house, and are therefore particularly useful in 
curing distempers. They partake of the nature of the earth, and have all great malignity, or 
some poisonous quality.' Further details are given after this manner : 

'Among medicines there are some which are in the place iTwni. or sovereign; other in the room 
Tehin or domestic servants; others that hold the place of Tso-che, or officers from without. 
Some partake of the nature of Yin, others of Yamj. Certain remedies have relations among 
themselves, like that of mother and child, and the eldest brother and younger. The physician 
Yuen-sou says, with respect to patients, that when the distemper lies in the upper cavity of the 
body, it is necessary to use the upper parts of plants ; when in the inferior cavity, which is 
the lower belly, the inferior parts of plants. The upper half of the body partakes of the 
Yang-, and is of the nature of the heaven ; the lower, of the Yin, and is of the nature of the earth. 
Li che tching divides drugs into seven classes, according to their quality, namely : 1. Simple ; they 
are never compounded, but are always taken alone, 2. Those that must be joined together, as 
for example. Gin seng, liquorice, the Hoamj Id, the Tchi mou, etc. 3. Those that lend each other 
mutual assistance. 4. Those that have a mutual antipathy, and which reciprocally render their 
virtues useless. 5. Those that fear or hurt each other. 6. Those that are contrary or incom- 
patible. 7. Those that destroy or kill each other. Drugs are distinguished according to taste, as 
sharp, salt, sweet, bitter, and strong; also according to the qualities of the air — cold or hot, 
temperate and fresh,' etc. 

The physician Ki-pe-cao says : ' There are inveterate and new distempers, likewise great 
receipts and small. If the disease has ten degrees of enormity, these medicines may diminish 
six, seven, or eight, according to their own degrees of malignity ; when medicines are used that 
have no malignant quality, out of ten degrees of the distemper they will take away nine. If the 
patient suffers from a distemper of &, poiKonous or malignant quality, and has a constitution able 
to resist strong remedies, a stronger dose may be given ; but to such as cannot bear them but 
with difficulty, the dose should be small. The same plants are different among themselves, on 
account of diversity of soil, or growing in the north or south; the different times in which they 



MEMORANDUM ON ' NATURAL SCIENCES.' 243 

spriDg up, and the parts of the plant.' According to Oong-tchi-yo : ' Those who purchase drugs 
and medicines ought to have two eyes ; one eye is sufficient for physicians who prescribe them, and 
those who take them need have no eyes at all.' Cao says : ' Medicines prepared by mastication 
were formerly in vogue, that is, before proper instruments were invented to cut and reduce them 
small. Physicians then chewed the simples they designed to use, squeezed out the juice, and gave 
it to the patient. This sort of preparation served to facihtate the motion of the humours upwards, 
and to distribute them more easily throughout the vessels.' 

Li ch^ tching says : ' In the First Age, the ancients prepared medicines, but seldom used them 
— their health was so perfect; in the Middle Age, virtue being degenerated and strength decayed, 
then disease arose. Of 1 0,000 persons who took medicine, there was not one who did not recover 
his former health.' He adds: 'As for the present time, medicines are used which are of a 
malignant and poisonous quality, for the cure of diseases when they lurk within the body ; and 
caustics, sharp instruments, and matches (mosas) to drive away the distemper, and yet all these 
inventions bring no great advantage.^ 

Chun-yn-y says : ' There are six sorts of distempers. The first, of the presumptuous or 
haughty, who will not listen to reason ; the second, of the covetous, who take greater care of 
their riches than of their own bodies ; the third, of the poor, who want the necessaries of life ; the 
fourth, of those who have the Tin and the Yang irregular; the fifth, of those who from weakness 
and want of flesh are not fit to take any sort of remedies ; the sixth, of those who give credit to 
quacks and impostors, and have no faith in regular physicians.' 

Tong-che says : ' Eegard must be had to the age and constitution of the patient, and to his 
present disposition, whether of plethora or of inanition; also whether the distemper be new or 
inveterate. It is necessary likewise to examine the degrees of malignity in poisonous medicines 
when they are made use of. In short, we must not obstinately adhere to the letter of this rule 
on all occasions ; but it must be moderated as different circumstances require. Each medicine 
ought to be proportioned to the distemper for which it is made.' 

Van-sou says that : ' The sages, or masters of medicine, when they make use of remedies to 
restore the health of the upper region, take special care not to excite any disorder in the lower 
region ; when in the lower region, not to disturb the upper ; when in the middle, not to affect 
the upper or lower.' Then follow various receipts, by Chinese physicians, for the cure of different 
diseases.' — (Du Halde, vol. iii.) 

Another very ancient work which gives an account of plants known by the Chinese in ancient 
times is the 'Eh-ya,' a dictionary of terms used in ancient Chinese writings, which, according to 
tradition, has been handed down from the twelfth century B.C. The greater part of the work, 
however, is attributed to Tsu-sia, a disciple of Confucias, consequently its actual date is about the 
fourth century B.C. It was divided into nineteen sections; it treats chiefly of natural objects; 
it gives an enumeration of nearly 300 plants, and as many animals, of which also drawings are 
given. In the fourth century of our era this work was commented on by Ko-p'o. 

The Chinese works on materia medica and plants from the sixth to the sixteenth century are very 
numerous. The epochs of the Tang family, 618 to 907 A.n., and the Sung, 960 to 1280 a.d., especially, 
were very productive in writers in this department. These works multiplied greatly; they 
became confused; they were full of faults, and wanting in proper arrangement. At the close of 
the sixteenth century, Li-shi-ch^n pubhshed his well-known treatise on Materia Medica, the 
' Pen-ts'ao-kang-mu,' having spent thirty years on the work, and made extracts from 800 authors, 
retaining everything that was good in them, and adding a great deal of his own. In the work 
thus completed there are 1,100 woodcuts of minerals, plants, and animals, and name or synonym 

31—2 



244 



EPITOME OP MEDICAL REPORTS. 



attached to eact. It is much to be desired that a regular list of these woodcuts should be 
drawn up^ and scientific names attached to such as can be identified. 

The whole work of Li-shi-chen embraces fifty-two chapters^ and is divided into several 
sections. Inorganic substances are arranged under the heads Water, Fire (chapters 5, ij), Earth, 
Metals, Gems, and Stone (chapters 7-11). Plants are comprised in twenty- six chapters (12— O?) ; 
Zoology in fourteen chapters (39-52 ) — (Bretschneider.) The following is a summary view of the 
contents of that work, and of the arrangement of the various subjects discussed in it, namely : — 



Chap 



■ [ Introductory Observations on the Practice of Med 



2.j 

^* r .Lists of Medicines for tlie Oare of all Diseases. 

^■) 

G. Earths. 
7.3 



ecine, and Index of Receipts. 



9. 
10. 
11. 

12. 

13.1 

14. 

15. 

16. 

17. 

18. 

19. 

20. 

21. 



22. 
23. 
24. 
25 



Mineral. — Metals. 
Gems. 

1. Stones. 

2. Stones. 

Saline stones— as common salt, alum, borax, sulphur, etc. 



i Vegetable. — 1st Division, Herhs. 



26. 

27. 



1. Hill plants. 

2. Odoriferous plants. 

3. Plants which grow in damp places. 

4. Poisonous plants. 

5. Creeping and climbing plants. 

6. Aquatic plants. 

7. Eock plants. 

8. Mosses and Lichens. 

9. Miscellaneous plants, and plants having names 
but not yet used in medicine. 

1. Hemp, wheat, rice, etc. 

2. Millet, maize, etc. 

3. Leguminous plants. 

4. Alimentary preparations of a vegetable nature, 

and used in medicine (as boiled rice, yeast, 
soy, vinegar, wine, etc.). 

3vd-Division,CuUnar>/ Herbs. 1. Plants having a strong colour and pungent 

taste (as garlic, mustard, ginger, etc.). 
2. Soft and smooth plants, pot-herbs (as lettuce, 
chicory, mallow, etc.). 



2nd Division, Grain.'^. 



MEMORANDUM ON 'NATURAL SCIENCES.' 



245 



CHAP. 

28. 

29. 
30. 
31. 
32. 

33. 

34. 
35. 
36. 

37. 

38. 

39. 
40. 
41. 
42. 

43. 

44. 

45. 
46. 

47. 
48. 

49. 
50. 
51. 

52. 



4th Division, Fruits. 



bth Division, Trees. 



On Garments and Domestic Utensils. 
Animal. — Tst Divison, Insects. 



' 3. Plants producing fruit upon the ground (as the 

gourd tribe). 
4. Aquatic vegetables (as edible sea-weeds). 
•5. Fungi. 

1. Cultivated fruits. 

2. Hill fruits. 

3. Foreign fruits. 

4. Aromatic fruits. 

5. Fruits which grow in the ground^ and have no 

kernels (as melons). 

6. Aquatic fruits. 

1. Aromatic trees. 

2. Stately trees. 

3. Bushy trees. 

4. Parasitic plants. 

5. Flexible plants and trees (as osier, bamboo, etc. ). 

6. Miscellaneous trees. 
(Appertaining to medicine). 

■ i Insects born from eggs. 

3. Insects produced by metamorphosis. 

4. Aquatic insects (including frogs.). 



2ndiDiYision, Scaly animals. \ ' „ 

' ■' (2. Serpents. 

f 3. Fishes having scales. 

\ 4. J, ,, no scales. 

SriDiyision, Shelly ani^nals. 1. Tortoises. 

2. Molluscs. 

4th Division, Birds. 1. Aquatic birds. 

2. Birds living upon open lands. 
I 3. „ „ in woods. 

i 4. Mountain birds. 

bthDWision, Hairy ani7nals. 1. Domestic quadrupeds. 

'2. Wild animals. 

3. Rodent animals. 
■ 4. Monkeys. 

6th Division, Man. 



(Parts of the human body, and human secretions 
and excretions employed in medicines). 

(See 'Science Papers,' by D. Hanbury, 1876, p. 214. Also, 'The Middle Kingdom,' by 
Williams, 1883, vol. i., p. 370). 



246 EPITOME OF MEDICAL EEPORTS. 

The first purely botanical work wMcli appeared in China seems to be the ' Nan-fang-ts'ao-mu- 
ch'uang/ by Ki-han, in the Tsin dynasty, 265.419 a.d. It'consists of four divisions, namely, herbs, 
trees, fruits, and bamboos ; and contains a description of 79 plants of Southern 
otany. China. About the close of the Ming dynasty, ended a.d. 16 lo, there appeared another 
botanical work — tho 'Kiin-fang-p'ii ' — aherbariun:i, in 30 books, compiled by Wang-siang-tsin; a 
considerably enlarged edition of that work was published in 1708, with the title 'Kuang-klin-p'u," in 
100 books. A review of the cultivated plants is also to be found in the ' Shou-shi-t'ung-kao,' a 
book on agriculture, horticulture, and the various industrial sciences, issued by order of the 
Emperor Yung Ching, in 1742, in 78 books. In 1848, the last Chinese treatise on botany of any 
note, named ' Chi-wu-ming-shi-tu'-ka'o,' was issued by Wu-k^i-sun. It contains 60 chapters, 
referring chiefly to plants now known to the Chinese, and includes 1,800 carefully executed 
drawings. 

In 1656, a pamphlet, bearing the title ' Flora Sinensis,' was published in Vienna. The author 
of that little work was Pater Boym, who had lived in China from 1643 to 1659. In 1682, a work 
on ' Chinese Materia Medica ' was published at Frankfort. It was edited by Andrew Cleyer, and 
contained, together with some Latin treatises, translations from the Chinese by Michael Boym, the 
Jesuit missionary above mentioned. In 1 712, the ' AmEenitates,' by Kaempfer. All the accounts of 
Chinese natural history, furnished by the Jesuits, and given by Father Martini, are collected in the 
work of Da Halde, ' Description de la Chine,' 1735. In 1750, a work by Osbeck appeared. In 1790, 
the ' Flora Cochin Chinensis ' was published by Louriero. In 1818, Grosier published his ' Descrip- 
tion generale de Chine,' in seven volumes. Nearly three of these treat of Chinese natural science, 600 
pages being devoted to botany. In 1836, a work, entitled ' An Historical and Descriptive Account 
of China,' was published by five authors, namely Murray, Crawford, Gordon, Wallace, and Burnet ; 
in that work is to be found a note, entitled ' Fragments towards a Flora of China.' (See Edinburgh 
Cabinet Gyclopedia.) In 1841, Bridgman's ' Chrestomathy ' contained three chapters, treating res- 
pectively of botany, zoology, and mineralogy. In 1846, the work by Williams appeared; besides 
several articles on this subject published in the ' Chinese Eepository.' Between 1849 and 1862 the 
several works by R. Fortune were published. In the former year the ' Mineralogia Polyglotta,' by 
Keferstern. In 1850, Dr. Tatarinov, Physician to the Russian Ecclesiastical Mission in Peking, dur- 
ing thetenyears,pablished a list of drugs obtained from the Chinese apothecary shops; as also alistof 
the plants growing around that city. In 1853,Hoffman's and Schulte's 'Noms indigenes d'un chois 
de plantes du Japon et de la Chine ' appeared. In 1856, a work was published at St. Petersburg, 
entitled ' Catalogus Medicamentarum Sinensium quas Pekini comperanda et determinanda curavit 
Alexander Tartarinov.' This work, an enlarged edition of that which appeared in 1850, includes 
the names of 500 medicinal substances. In 1861, the 'Flora Hongkongiensis' by Bentham appeared, 
the materials having been collected by Drs. Hinds, Hance, and Harland, Colonel Champion, and 
others. In 1862, D. Hanbury's "^ Notes on Chinese Materia Medica ' appeared, and since then 
they have been included among his ' Scientific Essays.-" Pere David has more recently gathered 
thousands of plants in China, which have yet to be carefully described. The Russian naturalists, 
Maximiwitch, Bunge, Bretschneider, Pressevalsky, besides those already named, have added 
to the knowledge of the plants of Mongolia, the Amoor basin, and the region about Peking. 
(' Science Papers,' by D. Hanbury, 1876, p. 211 ; 'Middle Kingdom,' by Williams, vol. i, p. 255; 
'The Study of Chinese Botanical Works,' by E. Bretschneider, p. 22.) 



MATERIA MEDIC A. 247 

XXIV. MATEEIA MEDICA. 

With a view to render the information regarding medicine generally in China as complete as 
possible, the following list is given of substances made use of in the treatment of disease by 
Chinese physicians, or popularly believed in. A careful perusal of that list can scarcely be 
made and the reader avoid the impression that the actual or supposed modus operandi of the 
substances enumerated had reference to particular theories of causation of disease which have 
come down from very ancient periods. For example, the enumeration of certain drugs as having 
'alexipharmic' properties naturally leads to the conclusion that from ancient times evendown 
to the present day the theory of ' specific poisons' in relation to particular diseases has remained 
in force. Among those described as such are abrus, linum, etc. 

On the assigned property of drugs named to expel ' phlegm,'' ' humours,' etc., we are thus led 
to the ' humoral theory' of disease. Inula, ricinus, salisburia, sinapis, etc., are drugs of this order. 

As in the present day, among Western nations, so in China, from time immemorial, certain 
drugs have been administered as prophylactics against certain diseases. Of this class, in China, 
are lonicera against fever, prunus against hydrophobia. 

So, also, the theory of 'blood-poisoning ' now in favour among the physicians of Europe and 
America is indicated as similarly existing in China by the circumstance of particular drugs being 
set apart as ' blood-purifiers.' Piper, daphnidium, and lophantes belong to this class. 

That the ' septic' theory has been accepted and acted upon in China is apparent from the 
fact of certain drugs being used as ' antiseptics ;' as, for example, the pollen of anandria — so also 
with regard to Citrus aurantia as a deodorant. A native drug, named k'oo-ch'ung, the exact 
nature of which has not been ascertained, is used as a disinfectant. — (No. 138c. p. 67, ' Vienna 
Catalogue '). 

The theory of ' similia similibus' was evidently that in accordance with which Scolopendra 
morsitans has, from time immemorial, been prescribed in chancre and other forms of syphilitic 
disease. 

The 'expectant' theory would explain the advantages of shells, fossils, horns, etc., as remedies 
in certain disorders. 

With reference to the use of the amethyst, hereafter to be noticed, the natural explanation is 
doubtless of the nature stated by Eoyle in regard to an Indian sage, who, ' after giving a pre- 
scription of precious stones for curing the diseases of kings and rich men, very judiciously adds 
another for people in general, composed of vegetables, because these are procurable by all.' 
— ('History of Hindoo Medicine,' p. 4.) 

What may be called the 'torpedo' theory of drugs, namely, that according to which 'a 
molecular mechanism, like a very cunningly devised torpedo, shall find its way to some particular 
group of living elements and cause an explosion among them, leaving the rest untouched' — 
(' Transactions of the International Medical Congress,' 1881, vol. i., p. 100)— is the modern coun- 
terpart of that in obedience to which the Chinese, for generations past, have prescribed inula, 
clematis, and the exuvise of serpents. See under these respectively. 

Dr. Hobson has given an analysis of 442 medicinal agents, enumerated in one of the popular 
dispensatories ; of the whole number, 314 are vegetable, 50 mineral, and 78 animal. Medicines 
are arranged under six heads — tonics, astringents, resolvents, purgatives, alteratives of poisonous 
humours, and of the blood. Among the agents employed are many strange and repulsive sub- 
stances. Calomel, vermilion, red precipitate, minium, red oxide of lead, arsenic, plumbago, and 
sulphate of copper are among the metallic medicines used by Chinese physicians ; and Dr. Hen- 
derson enumerates thirty-three distinct drugs of this class. — ('The Middle Kingdom,' vol. ii., p. 12 7.) 



248 EPITOME OF MEDICAL REPORTS. 

The following particulars have been taken from the ' Catalogue of the Vienna Exhibition, 
1873j and the ' Catalogue sp(^cial de la Collection exposee au Palais du Champs de Mars, 
Exposition Universelle/ 1878, pp. 57-98; 'The Middle Kingdom/ by Williams. Sir Joseph D- 
Hooker^ K.C.S.I., and Professor Oliver, of Kew, have kindly verified the nomenclature of the 
plants as under. 

a. From the Vegetable Kingdom. 

Abrus precatorius. — The seed : emetic^ ' alexipharmic ;' also as food for horses. 

Acacia catechu. — Cutch, or Catechu : applied to feet, renders the skin hard. 

Acanthopanax spinosa. — See Aralia palmata. 

Acer trifidum. — Leaves : the silk weavers of Wuhu drink in summer an infusion of the leaves, 

believing that this prevents their perspiration from soiling the silk. 
Achillsea. — See Ptarmica. 

conitum Anthora efc A. barbatum. — Root : stimulant, diuretic, alterative. As au antidote ; also 
against fever and hEemorrhoids. 
Fischeri (?) or A. barbatum. — Eoot : stimulant, diuretic, alterative. 

Sinense et A. japonicum. — The root: the powder is applied to ulcers and wounds; also to 
poison aiTows in killing game. Powder of that from Szechwan is used to produce 
local anassthesia. 
Sp.- — Root : used in certain renal diseases ; also considered tonic, astringent, styptic and anti- 
syphilitic, 
variegatum. — Root : much employed in Chinese medicine, to which it furnishes various 
drugs. Various species, used in fevers, leprosy, etc., after the poisonous properties have 
been diminished. 
Acorus calamus. — Root : powdered and in tincture ; as a restorative ; also in chancres. In 
haemoptysis, colic^ and fluxes. Applied to carbuncles, buboes, deaf ears, and sore 



terrestris. — Root : tonic, stimulant. In powder, used for tincture, in haemoptysis, colic, etc. 
Also anti-spasmodic, sedative, stomachic, etc. 
Adenophora trachelioides et A. verticillata. — The roots : expectorant, pectoral and emollient. 
Agaricus campestris, vel sp. (?). — Mushrooms: as delicacies, and also medicinally. 
Ailanthus glandulosa. — Bark of the root : in chronic dysentery very powerful as an astringent. 
Ajuga procumbens. — See Prunella. 
Algae. — A plant of this order, name not stated, is used in cases of dropsy. Another, taken in 

decoction in skin diseases, and to purify the blood; also in cases of goitre. 
Alisma plantago. — Rhizomes : said to be tonic, refreshing, diuretic, galactogogue, etc. 
Allium uliginosum. — Seeds : used to purify the blood ; in urinary diseases ; against spermatorrhoea 

and hsemorrhages. Fried in sesamum oil and applied hot, supposed to cure toothache. 
Aloe sinensis. — Aloes : anthelmintic, stomachic, purgative. 

Anchusa tinctoria. — Bark : used in dyeing. Medicinally, to bi'ing out the eruption of small-pox. 
Alpinia officinalis. — Galangal : used as a tonic. 

sinensis. — Root : stomachic, cordial, sialogogue, anti-periodic. 
Amomum sp. — Seeds : tonic, stomachic, coi'dial, astringent ; against incontinence of urine. Used 
also as condiments. 
(Cardamomum) A. xanthioides. — Seeds : in decoction as stomachic, tonic, carminative. Used 

in pyrosis, dyspepsia and pulmonary diseases ; said to drive away hypochondria, 
globosum. — Seeds : considered to have a useful action in tertian fevers ; also as condiments. 



FROM THE VEGETABLE KINGDOM. 249 

Amaryllis sp. (?). — Bulbs : alterative, given in scrofula, certain specific affections, anthraSj bydro- 

phobia, etc. 
Ampelopsis serianasfolia. — Roots : used as an astringent. 

Amygdalua Armeniaca.- — Almonds : as confection in quinsy, pains in the teetb, hydrophobia and 
worms. Sedative, antispasmodic, and conducive to longevity; used also for preparation 
of almond oil. 
Persica.— Almonds; vermifuge, emmenagogue ; in coughs; 'resolving;' given in rheumatism. 
Given also in blood diseases. 
Anandria bellidiastrum. — Pollen : as antiseptic in cases of wounds. 
Andropogon schcenanthus. — Root : used against eruptions of the hairy scalp. 
Anemone japonica. — Root : used to arrest vomiting. 
Anemarrhena asphodeloides. — Root : used much the same as squills ; in abdominal inflammations, 

and in puerperal fever. Cooling, lenitive, and diuretic. 
Angelica decursiva.— Root : slalagogue, carminative and stomachic, 
officinalis. — Root : as above. 
(Sp. ?) — As above; purgative and diaphoretic. 
Anthemis (sp. ?). — Flowers : stomachic. 

Apocynum juventus. — Root : used to dye black the beard. The Chinese attribute marvellous 
properties to it, as preserving a prolonged youth. Used in some diseases of the kidneys ; 
as a tonic, astringent, styptic, and antisyphilitic. 
Aquilaria chinensis. — The wood : burnt as a perfume by the Chinese. 
Arachis hypogea. — Seeds : cakes to fatten cattle. Yield the oil chiefly used for cooking purposes, 

and for lighting. Supposed to relieve chest affections. 
Aralia palmata or Acanthopanax spinosum. — The bark of the root : for the preparation of a 
tincture used in rheumatism and syphilis. A. edulis, prescribed in menstrual, chloretic, 
and puerperal diseases of women, 
papyrifera. — Pith : indicated as counter-irritant. 
Areca catechu. — Nuts : used medicinally as a purgative ; given in dropsical affections ; also 
as tonic, astringent, antiperiodic, anthelmintic. The husk is used in inflammations, 
with Chavica hetel leaves, as a masticatory. 
Arisffima triphyllum, or Pinellia tuberifera. — Root : in the fresh state emetic and diaphoretic ; dried, 

is used in fevers, rheumatism, and diseases of the kidnej's. 
Aristolochia oontorta. — Roots : purgative, hematic, anthelmintic ; also given in rabies. 

Ksempferi et A. contorta. — Fruit : used in pulmonary affections. 
Artemisia abrotanum. — Twigs : young shoots used in alimentation ; the juice is used in catarrh, 
jaundice, fever, and dysuria. 
dracunculus, or A. desertorum. — Whole plant and roots : used as anthelmintic, arthritic, and 

in skin diseases, 
eriopoda. — The plant : yields a kind of solid essential oil, like camphor. 
Indica. — Leaves : stomachic. 

Moxa et A. indica. Seeds : considered a sovereign remedy in hsemoptysis ; the leaf ignited 
upon the skin to cauterize the part. 
Arum macrourum vel Pinella tuberifera. — Bulbs : used in decoction in inflammation of the throat, 
pentaphyllum. — Root : alterative, deobstruent, diuretic, aperient, 'vulnerary,'' against apoplexy 
and hemiplegia. Also in the preparation of various drugs producing local anaesthesia. 
A species known as ' Midsummer root,'' in its fresh state, acts as an emetic ; the pre- 
pared root is given in fevers, rheumatism, etc. 

32 



250 EPITOME OE MEDICAL BEPORTS. 

Asparagus falcatus. — Root : anodyne. 

Atroctylodes alba. — Root : as stomachic and tonic. Is prepared as a kind of tea ; is warm 
stomacliic, and tonic, 
alba et A. chinensis. — Root : stomacliic, tonic, stimulant, diuretic. At Wuhu, a decoction 

is used when an eruption of dark spots (purpura ?) appears on the skin, 
ovata, var. f. pinnata. — Root : tonic, digestive, strengthening in cases of debility, 
rubra et A. sinensis. — Roots : stomachic, tonic, stimulant, diuretic, against chronic 
dysentery ; said to be conducive to longevity. 
Auklandia costus. — Herb : used in making iucense ; also as an astringent, sedative, and antiseptic. 

Balsamodendron myrrha. — The gum : applied as a powder to wounds as a purifier and healer. 

Also used in the form of plaster, and of decoction ; vulnerary, astringent. 
Bambusa arundo. — Rhizome : astringent, styptic, antifebrile, also demulcent, sedative, tonic. 

The leaves are reputed tonic, anthelmintic, stomachic, and carminative. The scraped 

bark of various species used as an astringent. 
Benincasa cerifera. — Rind of the fruit : used in consumption, chills, and asthma. Seeds : used 

to give ease in colic, spasms, etc. 
Berberis chinensis et B. aquifolia. — Fruit : with that of B. lycium, for preparing a cooling 

summer drink, tincture, tonic, and febrifuge. Infusion of leaves given for nervous 

headaches, fatigue, lassitude, and in feverish excitement. The juice of the fresh fruit 

is applied to weak eyes. The young shoots and leaves are used as a vegetable. 
Lycium et B. chinensis. — Root bark : made into a tincture, febrifuge, and tonic. Given in 

cases of measles in children ; also in rheumatism, remittent fever, and debility; to it 

are attributed many of the properties of quinine. 
Betonica oiBcinalis. — The stems : for headache, and colic. 

Biota (Thuja) orientalis. — Seeds : deprived of their envelopes, as stimulant and tonic ; also purgative. 
Blumea balsamifera. — A kind of camphor obtained by distilling the leaves of Blumea, and also 

of several other plants of the N. 0. Labiatse. 
Boswellia serrata et B. glabra. — Gum olibanum : used in plasters and decoctions; aa a stimulant 

and tonic. Also burnt as incense in temples. 
Boymia ruttecarpa. — Seed : alterative. 
Brassica napa. — Turnip-seed : laxative. 

Broussonetia papyrifera. — Seeds : tonic, refreshing, restorative, cooling. In menstrual disorders. 
Brunella vulgaris. — Leaves and stems used for diseases of the eyes. See Lophanthus rugosus. 
Bryonia cordifolia. — Root : in powder, purgative ; used for ulcers, pectoral and stomachic dis- 
orders, and for cooling the blood. 
Bryophyllum calycinum.— The leaves : cut and dried, are used in the falsification of tea. 
Bupleurum octoradiatum.^Root : antiartliritic and derivative. Also sudorific; in abdominal 

inflammations and puerperal fevers. Makes a refreshing tisane in cases of fever. 

Against swelling of the veins. 

Cffisalpinea sappan.— The wood : astringent, sedative and vulnerary. An excellent substitute for 

logwood. 
Calamus aromaticus. — Root : carminative. 

Calamus draco. — A dry resinous substance which covers the fruit : used as a tonic and astringent. 
Calophyllum.— Fruit : yields oil, and afterwards is used in the manufacture of soap. 
Cambogia gutta.— Gamboge : only for painting purposes. 



FROM THE VEGETABLE KINGDOM. 251 

Camellia japonica, 0. oleifera^ 0. sasanqua. — Flowers : those of the last-named species are 
odorant, and used to perfume tea. After the oil has been pressed from the seeds of C 
oleifera, the latter are made into cakes for feeding cattle. 

Campanula glauca vel Platycodon grandiflorum. — Root : as a substitute for ginseng, used as 
tisane in colds and chills. 

Camphora officinalis vel Laurus camphora. — Camphor : warm, diaphoretic, carminative, sedative, 
and as a stimulant ; deodorantj and in neuralgia. That from Borneo is from Dryoha- 
Icmops camphora. Also an essential oil of camphor. 

Capsicum (sp. ?). — Chillies : for seasoning purposes, and as a stimulant. 

Caragana flava et C. microphylla. — Roots : tonic, emollient, arthritic and prophylactic ; said to 
prolong existence. 

Carthamus tinctorius. — Flowers : stimulant, sedative, alterative, emmenagogue and abortifacient. 
In menstrual disorders. Used in fevers ; also as a dye with vinegar prepared from 
prunes, and as a component in the manufacture of rouge. 

Carum sp. — Seeds : used as an aromatic in abdominal disorders ; also in confectionery. 

CaryophylluSj two species. — Cloves : as a tincture in medicine, and as a hair-wash. 

Cassia. — Used for coughs and colds. 

Tora or Celosia argentea, or Thermopsis fabacea. — Seeds : all these, confounded under the 
same name, are said to clear the eyesight, and ' clean ■" the eyes diseased. Cassia oil is 
used as a condiment. 

Celosia argentea. — Seeds : ' penetrate the heart and livei',' and make heat of skin and pruritus 
to disappear. As an ingredient in emollient lotions, and as anti-ophthalmic. As an 
anthelmintic and tonic. The bruised seeds are stuffed into the nostrils in epistaxis. 

Cerasus communis. — Almonds : in rheumatism, dropsy, cardialgia, as anodyne and diuretic. 

Chavica Roxburghi. — Fruit : stimulant, stomachic, astringent ; in coryza, pyrosis, dysentery, 
hypertrophy of the spleen, and menstrual irregularities. C. betel : leaves as a masticatory. 

Chloranthus inconspicuus — The flowers are much used for giving to tea a cowslip scent; the tea 
thus scented is used in cases of fever. 

Chrysanthemum, or Pyrethrum sinense. — Flowers : used as tonic or sedative, antivinous. The 
small yellow flowers of a species mixed with tea are believed to possess ' cooling' pro- 
perties ; all tea-shops are accordingly supplied with them in the summer months. 
Indicum, also C. alba. — The flowers : in decoction, infusion and tincture ; in affections of 
the head, as a collyrium, and in affections following fever and chills ; calming, and as 
a cooling draught. Burnt, is used as an insecticide ; in powder, against intoxication. 

Cichorium (sp. ?). — Leaf-stalks : tonic, antiscorbutic, as a remedy in haemorrhoids. The root in 
dysentery, dysuria, etc. 

Cicuta, (sp. ?). — Root : stimulant, antispasmodic, arthritic. 

Cinnamomum Cassia. — Bark : stomachic, and as a condiment. 

Cirsium segetumet C. sinense. — Roots: nourishing, antiscorbutic, astringent; used also as cata- 
plasms in boils and engorgements. 
Sp. or Cnicus spicatus. — Root : antiscorbutic and astringent ; used as poultices in boils and 
engorgements. 

Cirsium, Cnicus, Centaurea and Carduus. — Alterative, astringent, and antiscorbutic, 

Cissus dissecta et 0. davidiana. — Stems : medicinal use undetermined. Believed to be used in 
dropsy. 

Citrus Aurantium. — Rind of the fruit : tonic and stomachic. The seeds are used as stimulant, 
carminative, antiphlogistic and deodorant. 

32—2 



252 EPITOME OF MEDICAL REPORTS. 

Prom Szecliwan.— The peel : bitter, stomacliic. The pips of all kinds of oranges, dried, are 

used as tonics and as condiments. 
Aurautia, var. scabra.— The rind : serves for a tincture, highly esteemed as sedative, carmina- 
tive, and sto:nachic. 
Decumana. — Rind of the fruit: used as a cordial in dyspepsia, and for cough. Stomachic 

and tonic, 
fusca. — Fruit : enters into a great many preparations. Refreshing and stomachic, 
medica (vel Sarcodactylus odoratus). — The rind: stomachic, tonic and stimulant. 
Citrus microcarpa. — Orange peel : stomachic, stimulant, tonic, and as a condiment. The unripe 
fruit is also used for these purposes, 
nobilis.- — Rind of the fruit : stomachic, stimulant. 
Clematis angustifolia. — Twigs: in decoction for iilcers. 

tubulosa. — Stems : ' penetrates the heart and small intestines, opens the bile, kills the 
nerves, excites all the senses and faculties.' 
Cnidium monnieri, or Selinum japonicum. — Seeds : anti-rheumatismal, aphrodisiac, and ' vulnerary. 
Cocculus thunbergii. — As carminative. From Szechwan. 

Coix lachryma. — Job's tears : as gruel, in rheumatism, night-sweats, lung and urinary affections, 
Colchicum variegatum. — See Uvularia. 

Convolvulus sp. — Root : against rheumatism, and grave affections of the bronchite and urinary 
passages. Three species or varieties are used, in spermatorrhoea, debility, and 
dyspepsia. They are often substituted for ginseng. 
Convolvulus (sp. ?) or Phyteuma (sp. ?). — Root : much employed against haemoptysis, heematuria, 
hemorrhages after parturition, and in dysuria. Often used as a substitute for ginseng. 
Used as a tonic by the poor; also in spermatorrhoea, as debility, and dyspepsia. 
Vel Phyteuma, vel Campanula (sp. ?). — Root : tonic. From Shansi. 
Cornus officinalis, — Fruit : astringent, febrifuge, vermifuge. 
Corydalis racemosa, vel Fumaeia officinalis. — The leaves and stems : used as a prophylactic 

against poisons. 
Corylus heterophylla. — Bark : emollient. 
Crateegus pinnatifida et cuneata. — Fruit, fresh and dry : as a peptic ; in jelly as a stomachic and 

refreshing drink. Used against indigestion. 
Croton tiglium.— Seeds and fruit: powerfullypurgative and emmenagogue. Chiefly from Szechwan. 
Cucumis et CitruUus. — The seeds : eaten as soothing, pectoral and pectic. 
Oucurbita melopepo et 0. citrullus. — Seeds : are mixed with pectoral and peptic medicaments. 

They are also eaien pour ]passer le temps. The rind, demulcent, in flatulency. 
Cupressus thyoides. — Kernels: stimulant and tonic; also as stomachic and antispasmodic. 
Cypress, or Juniper leaves, decocted, are considered soothing ; taken in cases of diarrhoea, 
dysentery, etc. 
Curcuma longa. — The seeds : used against colic. Root : in decoction, for ophthalmia ; in tincture, 
and as a condiment. 
(Sp. f) — Root. The precise plant is not yet determined. It is used as a perfume and in tinc- 
ture. 
Cuscuta monogyna et C. europea. — Seeds : diuretic, tonic and diaphoretic. 
(Sp. ?)— The plant : as an antiperiodic in fevers ; also as a febrifuge. 
Cydonia chinensis. — Fruit : sedative, stomachic, and astringent. 

Cymbidium sp. — Mucilaginous root : against rheumatism and neuralgia. Also in colouring. 
Cyperus esculentus et C. rotundus. — The tubercles : tonic, stimulant, stomachic and astringent. 



FROM THE VEGETABLE KINGDOM. 253 

Daphne Grenkwa. — Flowers : dried, infused in alcoholj used in Central China as a cordial, tonic 

and febrifuge. 
Daphnidium cuheb^ vel Laurus oubeba. — The fruits : imported from Coohin-China ; strength- 
ening, stomachic, carminative ; in decoction against hysteria, paralysis, loss of memory, 
strychnifolium vel Cocculus laurifolia. — Root : used as a remedy in ' diseases of the blood.^ 
Dendrobium Ceraia (?). — Stems: pass for stomachic, tonic, and antiphlogistic. 
Dianthus chinensis or D. fischeri. — Stems : diuretic, anthelmintic ; in collyria and as abortifacient. 
Dictamnus fraxinella. — Bark : aromatic, tonic. 
Dimorphanthus edulis and Levisticum sinense. — Root : given in decoction some days before 

accouchement, and to prevent accidents during that condition. 
Dioscorea sativa. — Root: pressed and dried; in powder, with finely ground flints and sesamum 

oil, applied to swellings. It is given internally in dyspepsia and emaciation. Said to 

increase the appetite, and to be conducive to corpulence. A preparation is used in 

diarrhoea. 
Diospyros kaki. — Calyx : used in medicine. A conserve of the pulp in coughs, colds, etc. The 

dried fruit is given in disorders of the stomach, and in diseases of the kidneys. As a 

preserve it is given to children affected with worms. 
Schitze. — Natural sugar exuded by the fruit: used in affections of the urinary passages; 

also a cooling drink is prepared from the fruit. 
Dolichos lablab. — Seeds : taken in great quantity, being considered protective against fever. 
(Sp. ?) — The beans fermented and salted, from Hupeh, are used as a sudorific. The small black 

kind are purgative. Soy is prepared from beans of Dolichos or Soya, 
trilobus. — Roots : emetic, antiphlogistic ; given in exanthemata, and all kinds of eruptions. 
Draba nemorosa. Seeds : stimulate the stomach ; used in epileptic and bronchial affections ; 

in asthma and in urinary diseases. 

Ephedra vulgaris, E. flava. — Roots and stems : derivative and sudorific. 

Equisetum arvense, hyemale, et racemosum. — The stem : as an astringent in diseases of the eyes. 

Briobotrya japonica. — Leaves : bitter ; they ' dissolve ' inflammations, arrest cough and thirst, 

appease melancholy, and strengthen the stomach; used only in the fifth and sixth 

months. The ' guitar dew ' is extracted from the leaves. 
Eriocaulon cantonense et E. setaceum. — Stems: as cephalic and styptic against epistaxis ; also 

vaunted in ophthalmia following small-pox in children. 
Erioglossum (?) or Nephelium (?). — Bungtalar of the Siamese. In China furnishes a jelly that is 

refreshing and laxative. Medicinal use iindetermined. 
ErythrEea (sp. ?). — As a cooling and arthritic remedy, and in affections of the eyes. 
Euonymus japonica. — Bark and root : against spermatorrhoea, excessive perspirations, and 

puerperal affections. Said to be tonic and invigorating. 
Euphorbia chamassyce. — The juice of the plant from Szechwan is used as a laxative. 

lasiocaula. — Stems : from Honan, purgative. 
Euryale ferox. — Fruit : with flour made into hard biscuits and thus used in medicine. In 

decoction, it is used in diseases of the skin. Also as a tonic. 

Fceniculum dulce. — Seeds : as medicine, and as seasoning. 

officinale. — Seeds : the entire plant is diuretic, tonic, ' anticephalic ■' also stimulant, and as a 
condiment. 
Ficus stipulata et Japonica (?). — Fruit : figs, boiled, are used as applications to hemorrhoids. 



254 EPITOME OF MEDICAL KEPORTS. 

Eilices. — An unnamed fern (' Nine-headed lion herb ') : is considered soothing and soporific. 
Given in cases of diarrhoea^ etc. 

Forsythia suspensa. — Capsules: diuretic, antiphlogistic, relaxant and emmenagogue ; also anti- 
dotal and antiscrophulous. 

Pumaria ofiicinalis. See Corydalis — Leaves : applied to swellings, abscesses, etc. 

Fungus (?). — Named Fiih-Iing : found growing from the roots of fir-trees. Used in syphilitic 
diseases. It is considered to be tonic, cooling, stomachic, sedative and diuretic. 

Gallge. — Galls : diifer in no way from those of Quercus infectoria. In powder, given in dysentery, 
chronic diarrhoea, nocturnal perspiration, etc. Several kinds of galls are distinguished 
according to the tree on which they are produced. Those of Quercus castancefoUa are 
called ' lo lo tong ;' those of Quercus robur, ' tchuen lo.' The ' mu-shi-tze ' differ 
in no way from the galls of Quercus infectoria. Those called ' wu-pei-tze ' are 
produced on the Rhus semi-alata by the A]phis chinensis. 

Gardenia florida, G. radicans, G. grandiflora. — Fruits : used to dye yellow. 

Gelidium (sp. ?). — The sea-weed from which CoUocaria brevirostris elaborates the jelly of 'Birds' 
nest soup.' 

Gendarussa sp. — Root : counter-irritant. Boiled in milk, it is given in rheumatism, fever, etc. 

Gentiana asclepiadea or G. squarrosa. — Root : in ophthalmia, liver complaints ; against snake- 
bite, and in hsematuria ; antiphlogistic and anti-rheumatismal. Boiled, and thus used 
as lotion in skin diseases. 

Gleditschia chinensis et G. heterophylla. — Fruits: pass for being emetic and purgative; and 
for being useful in a variety of diseases ; also anthelmintic, and used for dispelling 
swellings and tumours. The spines are used as an anthelmintic. The seeds and pods, 
in the shape of a bolus, are given as an antidote in cases of metallic poisoning. 

Glycirrhiza glabra et G. echinata. — Root : used to allay thirst, feverishness, etc. It is said to 
'rejuvenate' those who use it. The importance of liquorice is considered to be only 
next to that of ginseng. It is said to be highly nutritious. It is also tonic, alterative, 
and expectorant. 

Gynura pinnatifida. — Root : has a high reputation among soldiers, who attribute to it extra- 
ordinary medicinal properties. 

Hedysarum brachypterum. — Roots : astringent, styptic and vulnerary. 

Helminthochordon, Algge, Ulva, Conferva, Desmarestia, Chondrus, etc., are used as vermifuges. 

Hemerocallis (sp. ?). — Stems : medicinal use undetermined. See Lilium. 

Heterotropa asaroides. — Root : emetic, diaphoretic, diuretic, purgative, against rheumatism, and 
in apoplexy. 

Hibiscus abelmoschus. — Seeds : as emollient, demulcent, diuretic, laxative. 

mutabilis. — Flowers : given in infusion, as a pectoral in pulmonary affections. The leaves 

are used as applications to tumours. 
Syriacus. — Flowers : applied as emollients to boils. Leaves, as a poultice to swellings. 

Holcus sorghum. — The grains : as food j also as food for cattle, and in the manufacture of 
spirits. 

Hordeum distichum et H. hesastichum. — Barley : used principally in the manufacture of 
spirits. The sprouts are given as a stomachic. Much used in diseases of children 
generally. 

Hovenia dulcis. — Fruit : used to combat the odour of drunkenness, which it dissipates with re- 
markable rapidity. Used in indigestion. 



FROM THE VEGETABLE KINGDOM. 255 

Hydrocharis morsus-ranee vel Isolobus radicans. — The flowers : from its habit it is reputed 

refrigerant. 
Hypericum (sp. ?). — Leaves : used as an antidote. 

lUicium anisatum. — Chinese aniseeds : wai'm and fragrant ; infusion given in oases of fever. 

Impatiens Balsamina. — Roots and stems : a decoction is given to diminish the pain in surgical 
operations, and to facilitate delivery. 

Indigofera (sp. ?). — Eoot: this is not the indigo-yielding plant of commercOj although it bears 
that name. The present one is used in decoction for menstrual irregularities. Pure 
indigo is used for swellings, bruises, stings, and is also applied to strumous swellings. 

Ink (Chinese) is used as medicine in certain internal diseases. At Wuhu it is prepared by mixing 
ordinary soot with that obtained by burning oil of Sesamum, which see. 

Inula chinensis. — Flowers: they are believed to ' penetrate Hhe lungs, liver, the great intestine 
and ureters ; to expel the hamours and phlegms. Given in small doses to persons suffer- 
ing from debility. Also given as stomachic. 

Iris Florentina (?). — Rhizomes: tonic, emmenagogue, diaphoretic; in rheumatism, neuralgia, etc.; 
also used in the toilette. 
Ruthenica et I. Chinensis. — Leaves : extolled in puerperal affections. 

Jasminum nudiflorum. — Flowers : in decoction in ' cold in the head.' 

Sambac vel J. indica. — Flowers : used to perfume tea. 
Juglans (sp. ?). — Walnuts : supposed to have a beneficial effect upon the blood and kidneys. 
Juncus. — Rush ginger : the roots of a kind of rush ; applied internally in cases of ' scurvy or 

scabby heads ;' given in decoction internally in cases of rupture, etc. 
Juniperus excelsa et J. sinensis. — Leaves and branches : medicinal use undetermined. 
Justicia gendarussa (?). — Root : boiled with milk, against rheumatism, dysuria, and boils ; also in 
cases of jaundice. 
(Sp. ?) — Stems : medicinal use undetermined. 

Kadsura sinensis. — Dried fruit : tonic and aphrodisiac. 

Kochia scoparia. — Seeds : antiscorbutic. The entire plant is used for diarrhoea, dysentery, and 
disorders of the urinary organs. 

Lablab vulgaris. — The white seeds : eaten as preservative against fever. See Dolichos. 

Laminaria saccharina. — This alga, and several others, as Irideea, Rhodomaria, etc., are used 
against goitre ; also as strengthening. 
Scissa : against goitre, and in dropsy. 

Lamium petiolatum. — Medical use undetermined. 

Lappa major. — Seeds : medical use undetermined. 

Lemna gibba vel L. minor. — The 'water lentiles' make a refreshing potion, used in boils, 
syphilitic eruptions, and various affections of the skin; burnt after being dried, they 
drive away mosquitoes. 

Leonurus sibericus et L. sinensis. — Stems : as tonic, by the poor ; to re-establish menstruation ; 
also in affections of the skin ; and during confinements. Popularly it is said, ' Give me 
ten mace of " yi mu," and I guarantee that mother and infant do well.' 

Leontice (sp. ?) or Justicia paniculata, or Coptis trifolia. — The root : as a febrifuge. 

Levisticum chinense or Dimorphanthus edulis. — Root: in diseases of women; against haemor- 
rhages, diseases of the heart, etc. 

Libanotis siberica (Siler divaricatum, Benth. et Hook.) — Root : against catarrh and rheumatism 
Also in leprosy. 



25 G EPITOME OP MEDICAL REPORTS. 

Lichen (sp. ?). — Collected from rocks : medicinal use undetermined. 

Ligustrum glabrum et L. lucidum. — Seeds^ in tincture: against rheumatism. A kind of vegetable 
wax is obtained by boiling the fruit. 

Lilium candidum vel Polyanthes taberosa. — The bulbs : are boiled and eaten as a tonic with 
meat or rice; are considered to have cooling and ' refreshing' properties. Also given 
with chicken-broth. Used for coughs and other pulmonary affections. Much used in 
the sacrifices offered to ancestors. 

Linum usitatissimum. — Flax-seed : as emollientj arthritic^ anthelmintic, and alexipharmic. 

Lithospermum erythrorhizon. — The root : used against small-pox, to facilitate eruption of that 
disease, and to ' neutralize its poison.'' Also given in cases of ansemia. 

Lonicera chinensis, L. chrysantha, L. xylosteum, or L. flexuosa. — Flowers : applied to ulcers, 
against suppuration, in blenorrhagia, dropsy, syphilis ; as infusion and tincture. Per- 
sons subject to fever drink an infusion of the flowers of L. sinensis during the hot 
season. Flowers of L. xylosteum refrigerant; used in cases of rheumatism, syphilis, 
and dropsy. 

Lophanthus rugosus. — Seeds : ' Penetrate the lung, dispel the sad spirits, dissolve the phlegm, and 
dissipate cough.' Stomachic. Also the leaves, in affections of the blood, diseases of the 
eyes, and in scrofula. Used, in infusion, in fevers ; especially when the tongue is dry. 

Luffa Petola vel Cucumis longa. — Fruit : passes as galactagogue, anthelmintic, and is recom-